Achilles Tendon Pain

Overview
Achilles tendinitis (or Achilles tendonitis) is a strain of the Achilles tendon, which connects the calf muscles to the heel bone. Pain can be moderate or severe, but the condition is not usually serious. Of course, if you are suffering the leg and heel pain it brings, it certainly feels serious enough.

Causes
Achilles tendonitis is an overuse injury that is common especially to joggers and jumpers, due to the repetitive action and so may occur in other activities that requires the same repetitive action. Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or ageing. Anyone can have a tendon injury, but people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon. A tendon injury can happen suddenly or little by little. You are more likely to have a sudden injury if the tendon has been weakened over time. Common causes of Achilles tendonitis include, over-training or unaccustomed use,?too much too soon?. Sudden change in training surface e.g. grass to bitumen. Flat (over-pronated) feet, High foot arch with tight Achilles tendon. tight hamstring (back of thigh) and calf muscles, toe walking (or constantly wearing high heels). Poorly supportive footwear, hill running. Poor eccentric strength.

Symptoms
Symptoms can vary from an achy pain and stiffness to the insertion of the Achilles tendon to the heel bone (calcaneus), to a burning that surrounds the whole joint around the inflamed thick tendon. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day. This is especially true if your sheets are pushing down on your toes and thereby driving your foot into what is termed plantar flexion (downward flexed foot), as this will shorten the tendon all night.

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
Not every Achilles tendon injury or condition requires surgery. It is generally understood by doctors and surgeons, that surgery will introduce more scar tissue into the Achilles tendon. This added scar tissue will be problematic, requiring physical therapy and conservative treatment options post-surgery. If not dealt with properly, your ankle and Achilles tendon could end up in worse condition than before the surgery! This is why surgery is only performed as a last resort.

Prevention
So what are some of the things you can do to help prevent Achilles Tendinitis? Warm Up properly: A good warm up is essential in getting the body ready for any activity. A well structured warm up will prepare your heart, lungs, muscles, joints and your mind for strenuous activity. Balancing Exercises, Any activity that challenges your ability to balance, and keep your balance, will help what's called proprioception, your body's ability to know where its limbs are at any given time. Plyometric Training, Plyometric drills include jumping, skipping, bounding, and hopping type activities. These explosive types of exercises help to condition and prepare the muscles, tendons and ligaments in the lower leg and ankle joint. Footwear, Be aware of the importance of good footwear. A good pair of shoes will help to keep your ankles stable, provide adequate cushioning, and support your foot and lower leg during the running or walking motion. Cool Down properly, Just as important as warming up, a proper cool down will not only help speed recovery, but gives your body time to make the transition from exercise to rest. Rest, as most cases of Achilles tendinitis are caused by overuse, rest is probably the single biggest factor in preventing Achilles injury. Avoid over training, get plenty of rest; and prevent Achilles tendinitis.