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Overview<br>Achilles tendonitis is one of the most common running injuries. The achilles tendon is the large tendon at the back of the ankle. It connects the calf muscles made up of the gastrocnemius and soleus to the heel bone or calcaneus. It provides the power in the push off phase of walking and running where huge forces are transmitted through the achilles tendon. Achilles tendonitis is often now referred to as achilles tendinopathy. This is because the term tendinopathy covers all types of overuse achilles tendon injury. Strictly speaking tendonitis suggests an inflammatory condition of the tendon but in reality few achilles tendon injuries are actually down to pure inflammation. Soleus muscleThe main finding, particularly in older athletes is usually degeneration of the tissue with a loss of normal fibre structure. Other very similar conditions may actually be due to inflammation or degeneration of the tendon sheath which surrounds the tendon rather than the achilles tendon itself. In addition to being either chronic or acute, achilles tendonitis can also be at the attachment point to the heel called insertional achilles tendonitis or in the mid-portion of the tendon typically around 4cm above the heel. Healing of the achilles tendon is often slow, due to its poor blood supply.<br><br>Causes<br>Tendinitis most often occurs when a tendon is over used. As the foot extends the Achilles tendon engages the calf muscles. The calf muscle generates force, which is transferred to the foot via this tendon. As this action repeats the tendon will endure large amounts of stress. An under-trained or inexperienced athlete is most likely to be affected by tendinitis since their body is not accustomed to the stress involved with athletics. Improper foot mechanics is another common cause of Achilles tendinitis. A properly functioning foot will distribute weight evenly across the foot. On the contrary, if the foot is experiencing improper mechanics, the weight of the body will not be evenly distributed. This can result in tendinitis, plantar fasciitis, calluses, bunions, neuromas and much more.<br><br>Symptoms<br>People with Achilles tendinitis may experience pain during and after exercising. Running and jumping activities become painful and difficult. Symptoms include stiffness and pain in the back of the ankle when pushing off the ball of the foot. For patients with chronic tendinitis (longer than six weeks), x-rays may reveal calcification (hardening of the tissue) in the tendon. Chronic tendinitis can result in a breakdown of the tendon, or tendinosis, which weakens the tendon and may cause a rupture.<br><br>Diagnosis<br>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, [http://richard3bentley60.exteen.com/ 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.<br><br>Nonsurgical Treatment<br>Ask your Pharmacist for advice. 1) Your Pharmacy stocks a range of cold packs which may be applied to the area to decrease inflammation. 2) Ask your Pharmacist about a temporary heel raise or pad which can be inserted into footwear to decrease the force absorbed by the tendon when the feet land heavily on the ground. 3) Gently massaging a heat-producing liniment into the calf can help to relieve tension in the muscle which may relieve the symptoms of Achilles Tendinitis. Ask your Pharmacist to recommend the most appropriate type. 4) Gels, sprays or creams which help to reduce inflammation are available and may be applied to the injured area. Ask your Pharmacist for advice. 5) Your Pharmacist can advise you on analgesic, anti-inflammatory medications such as Aspirin which may be of assistance. Aspirin should be avoided in children under the age of 12 and those aged 12 to 15 who have a fever. 6) Strapping the ankle can help restrict movement and minimise further injury. Your Pharmacist stocks a range of athletic strapping tape and ankle guards which may assist your injury.<br><br><br>Surgical Treatment<br>For paratenonitis, a technique called brisement is an option. Local anesthetic is injected into the space between the tendon and its surrounding sheath to break up scar tissue. This can be beneficial in earlier stages of the problem 30 to 50 percent of the time, but may need to be repeated two to three times. Surgery consists of cutting out the surrounding thickened and scarred sheath. The tendon itself is also explored and any split tears within the tendon are repaired. Motion is started almost immediately to prevent repeat scarring of the tendon to the sheath and overlying soft tissue, and weight-bearing should follow as soon as pain and swelling permit, usually less than one to two weeks. Return to competitive activity takes three to six months. Since tendinosis involves changes in the substance of the tendon, brisement is of no benefit. Surgery consists of cutting out scar tissue and calcification deposits within the tendon. Abnormal tissue is excised until tissue with normal appearance appears. The tendon is then repaired with suture. In older patients or when more than 50 percent of the tendon is removed, one of the other tendons at the back of the ankle is transferred to the heel bone to assist the Achilles tendon with strength as well as provide better blood supply to this area.<br><br>Prevention<br>Your podiatrist will work with you to decrease your chances of re-developing tendinitis. He or she may create custom orthotics to help control the motion of your feet. He or she may also recommend certain stretches or exercises to increase the tendon's elasticity and strengthen the muscles attached to the tendon. Gradually increasing your activity level with an appropriate training schedule-building up to a 5K run, for instance, instead of simply tackling the whole course the first day-can also help prevent tendinitis.
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Overview<br>Achilles tendinitis is when the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot. This tendon is called the Achilles tendon. It is used for walking, running, and jumping.<br><br>Causes<br>There are a number of causes and risk factors associated with Achilles Tendinitis. One of the most common causes is simply a lack of conditioning. If the tendon, and muscles that connect to the tendon, have not been trained or conditioned, this can lead to a weakness that may result in an Achilles injury. Overtraining is also associated with Achilles Tendinitis. Doing too much, too soon places excessive strain on the Achilles tendon and doesn't allow the tendon enough time to recovery properly. Over time small tears and general degeneration result in a weakening of the tendon, which leads to inflammation and pain. Other causes of Achilles injury include a lack of warming up and stretching. Wearing inadequate footwear, running or training on uneven ground, and simply standing on, or in something you're not meant to. Biomechanical problems such as high arched feet or flat feet can also lead to Achilles injuries.<br><br>Symptoms<br>Common symptoms of Achilles tendinitis include, pain and stiffness along the Achilles tendon in the morning, pain along the tendon or back of the heel that worsens with activity, Severe pain the day after exercising, thickening of the tendon, bone spur (insertional tendinitis) swelling that is present all the time and gets worse throughout the day with activity, If you have experienced a sudden "pop" in the back of your calf or heel, you may have ruptured (torn) your Achilles tendon. See your doctor immediately if you think you may have torn your tendon.<br><br>Diagnosis<br>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, [http://oafishrubbish2046.exteen.com/20150622/hammer-toe-repair-surgery 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.<br><br>Nonsurgical Treatment<br>If you have ongoing pain around your Achilles tendon, or the pain is severe, book an appointment with your family physician and ask for a referral to a Canadian Certified Pedorthist. Your Pedorthist will conduct a full assessment of your feet and lower limbs and will evaluate how you run and walk. Based on this assessment, your Pedorthist may recommend a foot orthotic to ease the pressure on your Achilles tendon. As Achilles tendinitis can also be caused by wearing old or inappropriate athletic shoes for your sport, your Pedorthist will also look at your shoes and advise you on whether they have appropriate support and cushioning. New shoes that don?t fit properly or provide adequate support can be as damaging as worn out shoes.<br><br><br>Surgical Treatment<br>Surgery is considered the last resort. 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.<br><br>Prevention<br>Wear shoes that fit correctly and support your feet: Replace your running or exercise shoes before the padding or shock absorption wears out. Shock absorption greatly decreases as the treads on the bottoms or sides of your shoes begin to wear down. You may need running shoes that give your foot more heel or arch support. You may need shoe inserts to keep your foot from rolling inward. Stretch before you exercise: Always warm up your muscles and stretch gently before you exercise. Do cool down exercises when you are finished. This will loosen your muscles and decrease stress on your Achilles tendon. Exercise the right way: If your tendinitis is caused by the way that you exercise, ask a trainer, coach, or your caregiver for help. They can teach you ways to train or exercise to help prevent Achilles tendinitis. Do not run or exercise on uneven or hard surfaces. Instead, run on softer surfaces such as treadmills, rubber tracks, grass, or evenly packed dirt tracks.

Última revisión de 09:42 12 jun 2017

Overview
Achilles tendinitis is when the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot. This tendon is called the Achilles tendon. It is used for walking, running, and jumping.

Causes
There are a number of causes and risk factors associated with Achilles Tendinitis. One of the most common causes is simply a lack of conditioning. If the tendon, and muscles that connect to the tendon, have not been trained or conditioned, this can lead to a weakness that may result in an Achilles injury. Overtraining is also associated with Achilles Tendinitis. Doing too much, too soon places excessive strain on the Achilles tendon and doesn't allow the tendon enough time to recovery properly. Over time small tears and general degeneration result in a weakening of the tendon, which leads to inflammation and pain. Other causes of Achilles injury include a lack of warming up and stretching. Wearing inadequate footwear, running or training on uneven ground, and simply standing on, or in something you're not meant to. Biomechanical problems such as high arched feet or flat feet can also lead to Achilles injuries.

Symptoms
Common symptoms of Achilles tendinitis include, pain and stiffness along the Achilles tendon in the morning, pain along the tendon or back of the heel that worsens with activity, Severe pain the day after exercising, thickening of the tendon, bone spur (insertional tendinitis) swelling that is present all the time and gets worse throughout the day with activity, If you have experienced a sudden "pop" in the back of your calf or heel, you may have ruptured (torn) your Achilles tendon. See your doctor immediately if you think you may have torn your tendon.

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
If you have ongoing pain around your Achilles tendon, or the pain is severe, book an appointment with your family physician and ask for a referral to a Canadian Certified Pedorthist. Your Pedorthist will conduct a full assessment of your feet and lower limbs and will evaluate how you run and walk. Based on this assessment, your Pedorthist may recommend a foot orthotic to ease the pressure on your Achilles tendon. As Achilles tendinitis can also be caused by wearing old or inappropriate athletic shoes for your sport, your Pedorthist will also look at your shoes and advise you on whether they have appropriate support and cushioning. New shoes that don?t fit properly or provide adequate support can be as damaging as worn out shoes.


Surgical Treatment
Surgery is considered the last resort. 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
Wear shoes that fit correctly and support your feet: Replace your running or exercise shoes before the padding or shock absorption wears out. Shock absorption greatly decreases as the treads on the bottoms or sides of your shoes begin to wear down. You may need running shoes that give your foot more heel or arch support. You may need shoe inserts to keep your foot from rolling inward. Stretch before you exercise: Always warm up your muscles and stretch gently before you exercise. Do cool down exercises when you are finished. This will loosen your muscles and decrease stress on your Achilles tendon. Exercise the right way: If your tendinitis is caused by the way that you exercise, ask a trainer, coach, or your caregiver for help. They can teach you ways to train or exercise to help prevent Achilles tendinitis. Do not run or exercise on uneven or hard surfaces. Instead, run on softer surfaces such as treadmills, rubber tracks, grass, or evenly packed dirt tracks.

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