What Could We Do About Achilles Tendonitis

Overview
Achilles tendinitis is one of the more common causes of heel pain and many people describe it as pain in the back of the heel. Since this condition is a form of tendinitis, patients mostly notice that the back of their heel is inflamed. The Achilles tendon is the largest tendon in your body. It is also one of the most important and most used parts of the body. It is essential for walking, running, jumping or even just an extension of the foot. It is for this reason that Achilles tendinitis can affect anyone who is constantly putting stress on his or her foot. Athletes are particularly at risk.

Causes
Most common in middle-aged men. Conditions affecting the foot structure (such as fallen arches). Running on uneven, hilly ground, or in poor quality shoes. Diabetes. High blood pressure. Certain antibiotics. ?Weekend Warriors?. Recent increase in the intensity of an exercise program. While Achilles tendinitis can flare up with any overuse or strain of the Achilles tendon, it most often affects middle-aged men, especially if they are ?weekend warriors? who are relatively sedentary during the week, then decide to play basketball or football on Saturday. Those with flat feet or other structural conditions affecting their feet tend to put excess strain on the Achilles tendon, increasing their chances of developing Achilles tendinitis or even rupturing the tendon. If you are a runner, be sure to only run in quality running shoes that are supportive and well cushioned, and to be mindful of the surface you?re running on. Uneven surfaces and especially hilly terrain put additional strain on your Achilles tendon and can lead to the condition.

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
Supportive shoes and orthotics. Pain from insertional Achilles tendinitis is often helped by certain shoes, as well as orthotic devices. For example, shoes that are softer at the back of the heel can reduce irritation of the tendon. In addition, heel lifts can take some strain off the tendon. Heel lifts are also very helpful for patients with insertional tendinitis because they can move the heel away from the back of the shoe, where rubbing can occur. They also take some strain off the tendon. Like a heel lift, a silicone Achilles sleeve can reduce irritation from the back of a shoe. If your pain is severe, your doctor may recommend a walking boot for a short time. This gives the tendon a chance to rest before any therapy is begun. Extended use of a boot is discouraged, though, because it can weaken your calf muscle. Extracorporeal shockwave therapy (ESWT). During this procedure, high-energy shockwave impulses stimulate the healing process in damaged tendon tissue. ESWT has not shown consistent results and, therefore, is not commonly performed. ESWT is noninvasive-it does not require a surgical incision. Because of the minimal risk involved, ESWT is sometimes tried before surgery is considered.


Surgical Treatment
Surgery is considered when non-operative measures fail. Patient compliance and postoperative management is an important aspect of the operative management to prevent ankle stiffness or recurrence of the symptoms. Surgery usually requires a removal of the damaged tissue (debridement) and meticulous repair of the tendon. Post-operative immobilization is required, followed by gradual range of motion and strengthening exercises start. It may require 6 months for the full recovery. Some known complication are recurrence, stiffness of the ankle and deep vein thrombosis.

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.