tendinitis is an overuse injury of the Achilles (uh-KIL-eez) tendon, the band of tissue that connects calf muscles at the back of the lower leg to your heel bone. Under too much stress, the tendon
tightens and is forced to work too hard. This causes it to become inflamed (that?s Achilles tendinitis), and, over time, can produce a covering of scar tissue, which is less flexible than the tendon.
If the inflamed Achilles continues to be stressed, it can tear or rupture. Achilles tendinitis most commonly occurs in runners who have suddenly increased the intensity or duration of their runs.
It?s also common in middle-aged people who play sports, such as tennis or basketball, only on the weekends. Most cases of Achilles tendinitis can be treated with relatively simple, at-home care under
your doctor?s supervision. Self-care strategies are usually necessary to prevent recurring episodes. More-serious cases of Achilles tendinitis can lead to tendon tears (ruptures) that may require
Tight or fatigued calf muscles, which transfer the burden of running to the Achilles. This can be due to poor stretching, rapidly increasing distance, or over-training excessive hill running or speed
work, both of which stress the Achilles more than other types of running. Inflexible running shoes, which, in some cases, may force the Achilles to twist. Runners who overpronate (feet rotate too far
inward on impact) are most susceptible to Achilles tendinitis.
The Achilles tendon is a strong muscle and is not usually damaged by one specific injury. Tendinitis develops from repetitive stress, sudden increase or intensity of exercise activity, tight calf
muscles, or a bone spur that rubs against the tendon. Common signs and symptoms of Achilles Tendinitis include, gradual onset of pain at the back of the ankle which may develop in several days up to
several months to become bothersome. Heel pain during physical activities which may diminish after warming up in early stages, or become a constant problem if the problem becomes chronic. Stiffness
at the back of the ankle in the morning. During inactivity, pain eases. Swelling or thickening of the Achilles tendon. Painful sensation if the Achilles tendon is palpated. If a pop is heard
suddenly, then there is an increased chance that the Achilles tendon has been torn and immediate medical attention is needed.
Examination of the achilles tendon is inspection for muscle atrophy, swelling, asymmetry, joint effusions and erythema. Atrophy is an important clue to the duration of the tendinopathy and it is
often present with chronic conditions. Swelling, asymmetry and erythema in pathologic tendons are often observed in the examination. Joint effusions are uncommon with tendinopathy and suggest the
possibility of intra-articular pathology. Range of motion testing, strength and flexibility are often limited on the side of the tendinopathy. Palpation tends to elicit well-localized tenderness that
is similar in quality and location to the pain experienced during activity. Physical examinations of the Achilles tendon often reveals palpable nodules and thickening. Anatomic deformities, such as
forefoot and heel varus and excessive pes planus or foot pronation, should receive special attention. These anatomic deformities are often associated with this problem. In case extra research is
wanted, an echography is the first choice of examination when there is a suspicion of tendinosis. Imaging studies are not necessary to diagnose achilles tendonitis, but may be useful with
differential diagnosis. Ultrasound is the imaging modality of first choice as it provides a clear indication of tendon width, changes of water content within the tendon and collagen integrity, as
well as bursal swelling. MRI may be indicated if diagnosis is unclear or symptoms are atypical. MRI may show increased signal within the Achilles.
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.
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.
Suggestions to reduce your risk of Achilles tendonitis include, incorporate stretching into your warm-up and cool-down routines, maintain an adequate level of fitness for your sport, avoid dramatic
increases in sports training, if you experience pain in your Achilles tendon, rest the area. Trying to ?work through? the pain will only make your injury worse, wear good quality supportive shoes
appropriate to your sport. If there is foot deformity or flattening, obtain orthoses, avoid wearing high heels on a regular basis. Maintaining your foot in a ?tiptoe? position shortens your calf
muscles and reduces the flexibility of your Achilles tendon. An inflexible Achilles tendon is more susceptible to injury, maintain a normal healthy weight.