The Achilles tendon attaches
the calf muscle to the heel bone. Achilles tendonitis is a repetitive strain (overuse) injury involving lower leg muscles and tendons at the point where they attach to the bone, resulting in pain at
the back of the ankle. Chronic overuse can lead to small tears within the tendon causing long-term weakening, making the tendon susceptible to rupture, which could result in a need for surgery.
When you place a large amount of stress on your Achilles tendon too quickly, it can become inflamed from tiny tears that occur during the activity. Achilles tendonitis is often a result of
overtraining, or doing too much too soon. Excessive hill running can contribute to it. Flattening of the arch of your foot can place you at increased risk of developing Achilles tendonitis because of
the extra stress placed on your Achilles tendon when walking or running.
Achilles tendonitis and tendinopathy present as pain in the Achilles tendon, usually several centimeters above where it inserts on the heel. In some patients, pain and tendon damage are primarily at
the insertion to the heel bone. There may be swelling and/or thickening of the tendon. Bending at the ankle, walking, jumping, and running are often painful with this condition.
If you think you have Achilles tendinitis, make an appointment to see your doctor. The doctor will ask you questions about your recent activity and look for signs. The foot not flexing when the calf
muscle is pressed ( if Achilles ruptures or tears in half). Swelling on the back of the foot. Pain in the back of the foot. Limited range of motion in ankle. An X-ray or MRI scan can check for
The latest studies on Achilles tendonitis recommend a treatment plan that incorporates the following three components. Treatment of the inflammation. Strengthening of the muscles that make up the
Achilles tendon using eccentric exercise. These are a very specific type of exercise that has been shown in multiple studies to be a critical component of recovering from Achilles tendonitis.
Biomechanical control (the use of orthotics and proper shoes). Shockwave therapy.
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.
Stay in good shape year-round and try to keep your muscles as strong as they can be. Strong, flexible muscles work more efficiently and put less stress on your tendon. Increase the intensity and
length of your exercise sessions gradually. This is especially important if you've been inactive for a while or you're new to a sport. Always warm up before you go for a run or play a sport. If your
muscles are tight, your Achilles tendons have to work harder to compensate. Stretch it out. Stretch your legs, especially your calves, hamstrings, quadriceps, and thigh muscles - these muscles help
stabilize your knee while running. Get shoes that fit properly and are designed for your sport. If you're a jogger, go to a running specialty store and have a trained professional help you select
shoes that match your foot type and offer plenty of support. Replace your shoes before they become worn out. Try to run on softer surfaces like grass, dirt trails, or synthetic tracks. Hard surfaces
like concrete or asphalt can put extra pressure on the joints. Also avoid running up or down hills as much as possible. Vary your exercise routine. Work different muscle groups to keep yourself in
good overall shape and keep individual muscles from getting overused. If you notice any symptoms of Achilles tendonitis, stop running or doing activities that put stress on your feet. Wait until all
the pain is gone or you have been cleared to start participating again by a doctor.