Achilles Tendon Supports

Overview
Achilles-tendinitis is characterized by inflammation and pain at the Achilles tendon (back of the ankle). This tendon, sometimes called the heel cord, is the tendon attachment of the calf muscles from the leg and knee to the heel. This structure is important in standing on your toes or in the pushing-off phase of walking, running, or jumping.Achilles-tendinitis is usually a grade 1 or 2 strain of the tendon. A grade 1 strain is a mild strain. There is a slight pull of the tendon without obvious tendon tearing. (There is microscopic tendon tearing.) There is no loss of strength, and the tendon is the correct length. A grade 2 strain is a moderate strain. There is tearing of tendon fibers within the substance of the tendon or where the tendon attaches to muscle or bone. The length of the tendon or whole muscle-tendon-bone unit is increased, and there is usually decreased strength. A grade 3 strain is a complete rupture of the tendon.

Causes
Tendinitis typically develops after abrupt changes in activity or training level, use of poorly fit or worn footwear, or training on uneven or dense running surfaces. Overuse prior to sufficient training is generally the cause. This is due to forces 8-10 times the body weight acting on the tendon during physical activity. Achilles injuries range from inflammation to a breakdown in the tendon. Pain is generally felt low on the back of the heel due to the low vascularity and susceptibility for inflammation. Pain higher on the Achilles is generally more muscular pain and less tendonitis. If swollen spots or knots are found along the tendon, or if the tendon feels jagged, cease activity and seek professional medical care.

Symptoms
Achilles tendonitis typically starts off as a dull stiffness in the tendon, which gradually goes away as the area gets warmed up. It may get worse with faster running, uphill running, or when wearing spikes and other low-heeled running shoes. If you continue to train on it, the tendon will hurt more sharply and more often, eventually impeding your ability even to jog lightly. About two-thirds of Achilles tendonitis cases occur at the ?midpoint? of the tendon, a few inches above the heel. The rest are mostly cases of ?insertional? Achilles tendonitis, which occurs within an inch or so of the heelbone. Insertional Achilles tendonitis tends to be more difficult to get rid of, often because the bursa, a small fluid-filled sac right behind the tendon, can become irritated as well.

Diagnosis
A podiatrist can usually make the diagnosis by clinical history and physical examination alone. Pain with touching or stretching the tendon is typical. There may also be a visible swelling to the tendon. The patient frequently has difficulty plantarflexing (pushing down the ball of the foot and toes, like one would press on a gas pedal), particularly against resistance. In most cases X-rays don't show much, as they tend to show bone more than soft tissues. But X-rays may show associated degeneration of the heel bone that is common with Achilles Tendon problems. For example, heel spurs, calcification within the tendon, avulsion fractures, periostitis (a bruising of the outer covering of the bone) may all be seen on X-ray. In cases where we are uncertain as to the extent of the damage to the tendon, though, an MRI scan may be necessary, which images the soft tissues better than X-rays. When the tendon is simply inflamed and not severely damaged, the problem may or may not be visible on MRI. It depends upon the severity of the condition.

Nonsurgical Treatment
Initial treatment consists of medication and ice to relieve the pain, stretching and strengthening exercises, and modification of the activity that initially caused the problem. These all can be carried out at home, although referral to a physical therapist or athletic trainer for further evaluation and treatment may be helpful. Occasionally a walking boot or cast may be recommended to immobilize the tendon, allowing the inflammation to settle down. For less severe cases or after immobilization, a heel lift may be prescribed to reduce stress to the tendon. This may be followed by an elastic bandage wrap of the ankle and Achilles tendon. Orthotics (arch supports) may be prescribed or recommended by your physician. Surgery to remove the inflamed tendon lining or degenerated tendon tissue is rarely necessary and has shown less than predictable results.



Surgical Treatment
Surgery is considered the last resort and is often performed by an orthopedic surgeon. It is only recommended if all other treatment options have failed after at least six months. In this situation, badly damaged portions of the tendon may be removed. If the tendon has ruptured, surgery is necessary to re-attach the tendon. Rehabilitation, including stretching and strength exercises, is started soon after the surgery. In most cases, normal activities can be resumed after about 10 weeks. Return to competitive sport for some people may be delayed for about three to six months.

Prevention
As with all injuries, prevention is your best defense especially with injuries that are as painful and inconvenient as Achilles tendonitis. Options for how to prevent Achilles tendonitis include, stretching- Stretching properly, starting slowly, and increasing gradually will be critical if you want to avoid Achilles tendonitis. To help maintain flexibility in the ankle joint, begin each day with a series of stretches and be certain to stretch prior to, and after, any exercise or excessive physical activity. Orthotics and Heel Support- Bio-mechanically engineered inserts and heel cups can be placed in your shoes to correct misalignments or bolster the support of your foot and are available without a prescription. The temporary heel padding that these provide reduces the length that the Achilles tendon stretches each time you step, making it more comfortable to go about your daily routine. Proper Footwear- Low-heeled shoes with good arch support and shock absorption are best for the health of your foot. Look into heel wedges and other shoe inserts to make sure that your everyday foot mechanics are operating under ideal conditions.