Dealing With Achilles Tendinitis

Overview
Achilles tendinitis occurs when the band of tissue that connects the calf muscles at the back of the lower leg to the heel bone, the Achilles tendon, becomes inflamed. This condition is a result of overuse from intense exercise, jumping, running, and other activities that strain the tendon and calf muscles.

Causes
Short of a trauma, the primary cause of Achilles tendonitis is when the calf muscle is so tight that the heel is unable to come down to the ground placing extreme stress on the Achilles tendon at the insertion. Keep in mind that the calf muscle is designed to contract up, lifting the heel bone off the ground, propelling you forwards to the front of the foot for push off. When the calf is so tight that the heel is prevented from coming down on the ground there will be stress on the tendon and the foot will over pronate causing the Achilles tendon to twist, adding to the stress on the insertion. Improper treatment may lead to a more severe injury, such as a rupture or chronic weakening, which may require surgery.

Symptoms
If you have Achilles tendinitis or Achilles enthesopathy, you are likely to experience the following symptoms. Pain. You may notice aching, burning, or tearing pains at the back of your heel or above the ankle. The pain can range from mild to very severe and disabling. It is most noticeable in the following circumstances. After resting. Many people report that pain increases when they first get out of bed in the morning or after sitting for a period of time. After exercise. Pain may increase if you exercise or stand for a period of time. A lump. In some cases, a tender lump can develop at the site of the injured tendon (tendinosis). Bone spurs. When the injury occurs at the point where the tendon attaches to the foot, a bone spur may develop on the heel.

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
Proper footwear with a strong and secure counter (the heel circumference) may help to encourage heeling of the tendon. A tendinitis will occasionally resolve on it?s own, with rest, ice, and gentle stretching. If symptoms persist for more than 2 weeks, consult your physician. Your physician may suggest physiotherapy and custom orthotics. Physiotherapy can suggest appropriate exercises and modalities to aid in the healing process. Custom orthotics can be very successful in treating the problem, as the original cause may be due to an improper alignment of the foot and heel. Re-aligning the foot to a neutral position may provide an optimal, biomechanically sound environment for healing to occur.


Surgical Treatment
Treating this surgically, there are numerous methods to repair the tendon. Most commonly, Achilles tendon is exposed through an incision at the back of the ankle. After identifying both ends of ruptured tendon, the edges got trimmed and then both ends were sutured together with optimal tension. To get a better outcome with fixation, an anchor may have to be in place in calcaneus, provided the rupture is very low. Care must be taken to avoid injuries to the nerves located adjacent to the tendon.

Prevention
A 2014 study looked at the effect of using foot orthotics on the Achilles tendon. The researchers found that running with foot orthotics resulted in a significant decrease in Achilles tendon load compared to running without orthotics. This study indicates that foot orthoses may act to reduce the incidence of chronic Achilles tendon pathologies in runners by reducing stress on the Achilles tendon1. Orthotics seem to reduce load on the Achilles tendon by reducing excessive pronation,