What Leads To Achilles Tendonitis

Overview
Achilles tendinitis is very common among running athletes. The calf muscles attach to the calcaneus via the Achilles tendon. During running, the calf muscles help with the lift-off phase of gait. Repetitive forces from running combined with insufficient recovery time can initially cause inflammation in the tendon paratenon (fatty areolar tissue that surrounds the tendon). A complete tear of the Achilles tendon is a serious injury, usually resulting from sudden, forceful stress. Tendon tears can occur with minimal exertion in people who have taken fluoroquinolone antibiotics.

Causes
Some of the causes of Achilles tendonitis include, overuse injury - this occurs when the Achilles tendon is stressed until it develops small tears. Runners seem to be the most susceptible. People who play sports that involve jumping, such as basketball, are also at increased risk. Arthritis - Achilles tendonitis can be a part of generalised inflammatory arthritis, such as ankylosing spondylitis or psoriatic arthritis. In these conditions, both tendons can be affected. Foot problems - some people with flat feet or hyperpronated feet (feet that turn inward while walking) are prone to Achilles tendonitis. The flattened arch pulls on calf muscles and keeps the Achilles tendon under tight strain. This constant mechanical stress on the heel and tendon can cause inflammation, pain and swelling of the tendon. Being overweight can make the problem worse. Footwear - wearing shoes with minimal support while walking or running can increase the risk, as can wearing high heels. Overweight and obesity - being overweight places more strain on many parts of the body, including the Achilles tendon. Quinolone antibiotics - can in some instances be associated with inflammatory tenosynovitis and, if present, will often be bilateral (both Achilles), coming on soon after exposure to the drug.

Symptoms
Achilles tendinitis symptoms present as mild to severe pain or swelling near the ankle. The pain may lead to weakness and decreased mobility, symptoms that increase gradually while walking or running. Over time, the pain worsens, and stiffness in the tendon may be noted in the morning. Mild activity may provide relief. Physical exam may reveal an audible cracking sound when the Achilles tendon is palpated. The lower leg may exhibit weakness. A ruptured or torn Achilles tendon is severely painful and warrants immediate medical attention. The signs of a ruptured or torn Achilles tendon include. Acute, excruciating pain. Impaired mobility, unable to point the foot downward or walk on the toes. Weight bearing or walking on the affected side is not possible.

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
Wear shoes with a low half-inch to one-inch heel that are somewhat flexible through the ball of the foot. Avoid flat footwear such as slippers or sandals and stiff shoes. Add a heel lift in your shoe. You may also use arch support inserts or orthotic insoles. Heel lifts and orthotics can be purchased at many of our pharmacies and Podiatry departments. Avoid standing or walking barefoot. Perform calf-stretching exercises for 30 to 60 seconds on each leg at least 2 times a day. Stand an arm?s length away from a wall, facing the wall. Lean into the wall, stepping forward with one leg, leaving the other stretched behind you. The leg behind you is the one being stretched. Keep this leg straight (locked) and the toes pointed straight at the wall. Stretch forward until you feel tightness in the calf of your back leg. Hold this position without bouncing for 30 to 60 seconds. Repeat for the opposite leg. Do stair exercises every day. Stand facing the stairs with the ball of your foot on a stair and your heel hanging off. Balance on one foot at a time while holding onto the rail. Slowly lower your heel as low as it will drop down and then slowly raise it up as high as you can lift it. Repeat this exercise slowly several times on each foot. Perform this exercise every other day, gradually increasing the number of repetitions over time as tolerated. If you are overweight, talk to your personal physician about resources that can help you lose weight. Carrying excess weight places additional pressure on your feet. Decrease the time that you stand, walk, or engage in exercises that put a load on your feet. Switch to a nonimpact form of exercise until your tendon heals, such as swimming, pool running, and using an elliptical trainer.



Surgical Treatment
Many people don't realize that Achilles tendon surgery can be very traumatic to your body. The type of trauma you experience after surgery can be compared to what you go through when you first injured your Achilles tendon. During the first 24 to 72 hours after the surgery your ankle will be tender, swollen and very painful. Your leg will be weak and unstable making it impossible for you to put weight on your leg without some kind of help. This is why your doctor or surgeon will have you outfitted for a cast, ankle brace and/or crutches before the procedure. When you are relying on a cast/brace and crutches your Achilles tendon is less likely to be as active as it once was. This is usually why atrophy (loss) of your lower leg muscles (specifically your calf muscle) happens. In general, more than 80%* of people who undergo surgery for an injured Achilles Tendon are able to return to their active lifestyle. In order to avoid re-injury, it is important to commit to a regular conservative therapy routine.

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.