Regarding Achilles Tendinitis

Overview

Achilles tendinitis can be a very crippling issue for runners – simply because the pain is enough to discourage loading of the foot. It can also be a tricky condition to treat because the tendon is not as heavily vascularized (i.e. more blood flow) as muscle, and therefore lacks healing potential. It is highly recommended that you see a physical therapist as soon as you experience acute symptoms, so chronic tendonosis (which is longer termed and harder to treat) does not set in.

Causes

Hill running or stair climbing. Overuse resulting from the natural lack of flexibility in the calf muscles. Rapidly increasing mileage or speed. Starting up too quickly after a layoff. Trauma caused by sudden and hard contraction of the calf muscles when putting out extra effort such as in a final sprint. Achilles tendinitis often begins with mild pain after exercise or running that gradually worsens.

Symptoms

The pain associated with Achilles tendinitis typically begins as a mild ache in the back of the leg or above the heel after running or other sports activity. Episodes of more severe pain may occur after prolonged running, stair climbing or sprinting. You might also experience tenderness or stiffness, especially in the morning, which usually improves with mild activity. If you experience persistent pain around the Achilles tendon, call your doctor. Seek immediate medical attention if the pain or disability is severe. You may have a torn (ruptured) Achilles tendon.

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

In addition to stretching, using a foam roller and getting regular massage to keep the joint mobile can help prevent any problems from starting. If you start to feel inflammation in your tendon or have Achilles tendinitis once, it isn?t necessarily the end of the world. Let it rest and recover, which can sometimes take as long as four to six weeks if you waited until the pain was acute. The real problem is if Achilles tendinitis becomes an ongoing injury. If it keeps recurring, then it?s time for the perpetually injured to examine what they?re doing to cause the problem.

Surgical Treatment

Mini-Open Achilles Tendon Repair. During a mini-open Achilles tendon repair surgery, 2 to 8 small stab incisions are made to pull the edges of the tendon tear together and suture the torn edges to repair the damage. During this procedure the surgeon will make one 3 to 4 cm long incision on the back of your ankle and 2 to 4 smaller vertical incisions around the long incision. These smaller veritical incisions are made with a pair of surgical scissors and are commonly referred to as “stab incisions”. Once the incisions are opened up, the surgeon will place precise sutures with non-absorbable stitches to strengthen the damaged Achilles tendon tissue. This suturing technique reduces the amount of scar tissue on the tendon after surgery and provides better surface healing of the skin. Unlike the traditional method of an open surgery, this procedure has less risks and complications involved. To learn about all risks you may face be sure to speak to your doctor.

Prevention

By properly training the body, an athlete can build the strength of their tendons and muscles. Following a workout and dieting plan, the body will be able to build muscle and strengthen most effectively. Additionally, doing the following can prevent tendinitis. Wearing appropriate shoes will give your foot the support it needs for proper movements of the foot and ankle. Improper movements will put additional stress on your body. Stretching before an athletic activity, Stretching primes the body for a taxing activity. Additionally, this will get your blood flowing and reduce the risk of pulling a muscle. Ask your doctor about orthotics, Custom orthotics can help get your foot into proper alignment. If the foot does not execute proper mechanics, the body will adjust which will cause pain and increase the chances of injury.

Achilles Tendonitis The Facts

Overview

Inflammation of the Achilles tendon.The Achilles is the large tendon connecting the two major calf muscles, gastrocnemius and soleus, to the back of the heel bone. Under too much stress, the tendon tightens and is forced to work too hard. This causes it to become inflamed (that is 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.

Causes

Possible factors leading to the development of Achilles tendonitis include the following. Implementing a new exercise regiment such as running uphill or climbing stairs. Change in exercise routine, boosting intensity or increasing duration. Shoes worn during exercise lack support, either because the soles are worn out or poor shoe design. Omitting proper warm-up prior to strenuous exercise. Running on a hard or uneven surface. Deformation in foot such as a flat arch, or any anatomic variation that puts unnecessary strain on the Achilles tendon.

Symptoms

Patients with this condition typically experience pain in the region of the heel and back of the ankle. In less severe cases, patients may only experience an ache or stiffness in the Achilles region that increases with rest (typically at night or first thing in the morning) following activities which place stress on the Achilles tendon. These activities typically include walking or running excessively (especially uphill or on uneven surfaces), jumping, hopping, performing heel raises or performing calf stretches. The pain associated with this condition may also warm up with activity in the initial stages of injury. As the condition progresses, patients may experience symptoms that increase during sport or activity, affecting performance. Pain may also increase when performing a calf stretch or heel raise (i.e. rising up onto tip toes). In severe cases, patients may walk with a limp or be unable to weight bear on the affected leg. Patients with Achilles tendonitis may also experience swelling, tenderness on firmly touching the Achilles tendon, weakness and sometimes palpable thickening of the affected Achilles tendon when compared with the unaffected side.

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

The initial aim of the treatment in acute cases is to reduce strain on the tendon and reduce inflammation until rehabilitation can begin. This may involve, avoiding or severely limiting activities that may aggravate the condition, such as running or uphill climbs. Using shoe inserts (orthoses) to take pressure off the tendon. Wear supportive shoes. Reducing Inflammation by icing. Taking non-steroidal anti-inflammatory drugs. Heel cups and heel lifts can be used temporarily to take pressure off the tendon, but must not be used long term as it can lead to a shortening of the calf. Calf Compression Sleeves. Placing the foot in a cast or restrictive ankle-boot to minimize movement and give the tendon time to heal. This may be recommended in severe cases and used for about eight weeks.

Surgical Treatment

Mini-Open Achilles Tendon Repair. During a mini-open Achilles tendon repair surgery, 2 to 8 small stab incisions are made to pull the edges of the tendon tear together and suture the torn edges to repair the damage. During this procedure the surgeon will make one 3 to 4 cm long incision on the back of your ankle and 2 to 4 smaller vertical incisions around the long incision. These smaller veritical incisions are made with a pair of surgical scissors and are commonly referred to as “stab incisions”. Once the incisions are opened up, the surgeon will place precise sutures with non-absorbable stitches to strengthen the damaged Achilles tendon tissue. This suturing technique reduces the amount of scar tissue on the tendon after surgery and provides better surface healing of the skin. Unlike the traditional method of an open surgery, this procedure has less risks and complications involved. To learn about all risks you may face be sure to speak to your doctor.

Prevention

By properly training the body, an athlete can build the strength of their tendons and muscles. Following a workout and dieting plan, the body will be able to build muscle and strengthen most effectively. Additionally, doing the following can prevent tendinitis. Wearing appropriate shoes will give your foot the support it needs for proper movements of the foot and ankle. Improper movements will put additional stress on your body. Stretching before an athletic activity, Stretching primes the body for a taxing activity. Additionally, this will get your blood flowing and reduce the risk of pulling a muscle. Ask your doctor about orthotics, Custom orthotics can help get your foot into proper alignment. If the foot does not execute proper mechanics, the body will adjust which will cause pain and increase the chances of injury.