Achilles Tendonitis
What is Achilles Tendonitis?
It is estimated that achilles tendonitis accounts for around 11% of all running injuries. The Achilles tendon is the largest and most vulnerable tendon in the body. It joins the gastrocnemius (calf) and the soleus muscles of the lower leg to heel of the foot. The gastrocnemius muscle crosses the knee, the ankle, and the subtalar joints and can create stress and tension in the Achilles tendon. Tendons are strong, but not very flexible so they can only so far before they get inflammed and tear or rupture.
Causes of Achilles Tendonitis
Achilles tendonitis is a chronic injury that occurs primarily from overuse. It tends to come on gradually over time until pain is constant and exercise or activity too painful to continue. The biggest cause of chronic Achilles tendonitis is ignoring early warning signs and pushing through pain. If the Achilles tendon is sore, or aches, you need to pay attention and rest it immediately.
Another major contributor in the development of Achilles tendonitis is tight of weak calf muscles. If this muscle is weak and becomes fatigued, it will tighten and shorten. Overuse also causes muscle fatigue. The bottom line with Achilles tendonitis is that the more fatigued the calf muscles are (regardless if it is from weakness or overuse), the shorter and tighter they will become. This tightness increases the stress on the Achilles tendon, and a tendonitis can develop. Sudden increases in training, hill running or a lot of speedwork can also lead to Achilles tendonitis.
The two most common causes of Achilles tendonitis are:
Symptoms of achilles tendonitis (tendinitis)
Symptoms for acute inflammation of the Achilles tendon are:
- Pain on the tendon during exercise. Achilles pain will gradually come on with prolonged exercise but will go away with rest.
- Swelling over the Achilles tendon.
- Redness over the skin.
- You can sometimes feel a creaking when you press your fingers into the tendon and move the foot.
Chronic achilles tendinitis may often follow on from acute achilles tendinitis if the acute tendon injury is not treated properly or allowed to heal. Chronic Achilles tendonitis is a difficult condition to treat, particularly in older athletes who appear to suffer more often. The pains experienced during the acute phase of the injury tend to disappear after a warm up but return when training has stopped. Eventually the injury gets worse and worse until it is impossible to run.
Symptoms for chronic Achilles tendonitis are similar to those of acute tendonitis as well as:
- Pain and stiffness in the Achilles tendon especially in the morning. This pain may be described as diffuse along the tendon rather than specific.
- There may nodules or lumps in the achilles tendon, particularly 2cm above the heel.
- Pain in the tendon when walking especially up hill or up stairs.
- Chronic tendonotis differs from acute tendinitis in that it is more of a long term persistent problem.
Treatment
The best treatment of Achilles tendonitis is prevention. Stretching the Achilles tendon before exercise, even at the start of the day, will help to maintain flexibility in the ankle joint. Problems with foot mechanics can also be treated with devices inserted into the shoes. Products such as heel cups, arch supports, and custom orthotics can be used to correct for abnormalities such as overpronation and help prevent Achilles tendonitis. Shoe inserts for foot and heel pain or correct footware
The treatments of Achilles tendonitis include:
- Rest
Resting the painful Achilles tendon will allow the inflammation to subside and allow for healing. A period of rest after the onset of symptoms is important in controlling Achilles tendonitis.
- Immobilization
In patients who have more significant symptoms, a period of immobilization can help. Either a removable walking boot, or sometimes even a cast, can allow the inflamed tissue to cool down quickly.
- Heel Wedge
A heel wedge can be inserted into the shoe to minimize the stress on the Achilles tendon. These can be placed in both athletic shoes and work shoes.
- Ice the Injury
Applying ice to the area of inflammation can help stimulate blood flow to the area, and relieve the pain associated with inflammation. Apply ice after exercise, as well as several other times over the course of the day.
- Anti-Inflammatory Medications
Nonsteroidal anti-inflammatory medications (NSAIDs) include a long list of possibilities such as Ibuprofen, Motrin, Naprosyn, Celebrex, and many others.Achilles tendonitis treatment can be improved by these medications that will decrease pain and swelling. Be sure to talk to your doctor before starting these medications.
- Physical Therapy
Physical therapists can help formulate a stretching and rehabilitation program to work on flexibility of the Achilles tendon.
Cortisone injections are infrequently used in patients with Achilles tendonitis because studies have shown an increased incidence of Achilles tendon rupture after cortisone injections.
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