Achilles Tendonitis Facts

Overview

Achilles TendonAchilles tendon injuries are one of the most common overuse injuries in recreational sports. A very small percentage of these injuries are diagnosed and treated by doctors of chiropractic. What is especially interesting is that a high percentage of these injuries are caused by a posterior calcaneus subluxation.


Causes

Poorly conditioned athletes are at the highest risk for developing Achilles tendonitis, also sometimes called Achilles tendinitis. Participating in activities that involve sudden stops and starts and repetitive jumping (e.g., basketball, tennis, dancing) increases the risk for the condition. It often develops following sudden changes in activity level, training on poor surfaces, or wearing inappropriate footwear. Achilles tendonitis may be caused by a single incident of overstressing the tendon, or it may result from a series of stresses that produce small tears over time (overuse). Patients who develop arthritis in the heel have an increased risk for developing Achilles tendonitis. This occurs more often in people who middle aged and older. The condition also may develop in people who exercise infrequently and in those who are just beginning an exercise program, because inactive muscles and tendons have little flexibility because of inactivity. It is important for people who are just starting to exercise to stretch properly, start slowly, and increase gradually. In some cases, a congenital (i.e., present at birth) condition causes Achilles tendonitis. Typically, this is due to abnormal rotation of the foot and leg (pronation), which causes the arch of the foot to flatten and the leg to twist more than normal.


Symptoms

People with Achilles tendinitis may experience pain during and after exercising. Running and jumping activities become painful and difficult. Symptoms include stiffness and pain in the back of the ankle when pushing off the ball of the foot. For patients with chronic tendinitis (longer than six weeks), x-rays may reveal calcification (hardening of the tissue) in the tendon. Chronic tendinitis can result in a breakdown of the tendon, or tendinosis, which weakens the tendon and may cause a rupture.


Diagnosis

Laboratory studies usually are not necessary in evaluating and diagnosing an Achilles tendon rupture or injury, although evaluation may help to rule out some of the other possibilities in the differential diagnosis. Imaging studies. Plain radiography: Radiographs are more useful for ruling out other injuries than for ruling in Achilles tendon ruptures. Ultrasonography: Ultrasonography of the leg and thigh can help to evaluate the possibility of deep venous thrombosis and also can be used to rule out a Baker cyst; in experienced hands, ultrasonography can identify a ruptured Achilles tendon or the signs of tendinosis. Magnetic resonance imaging (MRI): MRI can facilitate definitive diagnosis of a disrupted tendon and can be used to distinguish between paratenonitis, tendinosis, and bursitis.


Nonsurgical Treatment

Tendon inflammation should initially be treated with ice, gentle calf muscle stretching, and use of NSAIDs. A heel lift can be placed in the shoes to take tension off the tendon. Athletes should be instructed to avoid uphill and downhill running until the tendon is not painful and to engage in cross-training aerobic conditioning. Complete tears of the Achilles tendon usually require surgical repair.

Achilles Tendon


Surgical Treatment

In cases of severe, long-term Achilles tendonitis the sheath may become thick and fibrous. In these cases surgery may be recommended. Surgery aims to remove the fibrous tissue and repair any tears in the tendon. A cast or splint will be required after the operation and a recovery program including physiotherapy, specific exercises and a gradual return to activity will be planned.


Prevention

If you’re just getting started with your training, be sure to stretch after running, and start slowly, increasing your mileage by no more than 10% per week. Strengthen your calf muscles with exercises such as toe raises. Work low-impact cross-training activities, such as cycling and swimming, into your training.

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All The Things You Need To Know Regarding Achilles Tendonitis

Overview

Achilles TendinitisTendinitis is inflammation of a tendon. Thus, Achilles tendinitis is an inflammation of the Achilles tendon. The inflammation may be localized to the end of the tendon closest to the heel or may spread upward to affect even the muscles of the calf. Swelling often occurs and pain is felt upon contraction of the calf muscles. In severe cases, pain may be felt even at rest. Generally, Achilles tendinitis begins as a dull pain at the back of the lower leg just above the heel when pushing off the ground with the foot. Unless the activity is stopped, the condition rapidly gets worse until any activity requiring a push-off from the ground by the foot becomes quite painful and nearly impossible. If it is left untreated, it can develop into one of two more serious conditions – Achilles tendinosis and Insertional Calcific Tendinitis.


Causes

A lot of stress on the feet is the cause of Achilles tendinitis. It is a common athletic injury. Things that can cause tendinitis include, pushing your body too fast and too soon, sudden increase in activity, sports that cause you to quickly start and stop, poor fitting shoes, bad footwear, severe injury to the Achilles tendon, running or exercising on uneven ground, running uphill, tight calf muscles, bone spur (extra bone growth in heel that rubs the tendon and causes pain), flat arches, feet that roll in (overpronation), and weak calf muscles, not warming up before exercising.


Symptoms

Achilles tendinitis symptoms present as mild to severe pain or swelling near the ankle. The pain may lead to weakness and decreased mobility, symptoms that increase gradually while walking or running. Over time, the pain worsens, and stiffness in the tendon may be noted in the morning. Mild activity may provide relief. Physical exam may reveal an audible cracking sound when the Achilles tendon is palpated. The lower leg may exhibit weakness. A ruptured or torn Achilles tendon is severely painful and warrants immediate medical attention. The signs of a ruptured or torn Achilles tendon include. Acute, excruciating pain. Impaired mobility, unable to point the foot downward or walk on the toes. Weight bearing or walking on the affected side is not possible.


Diagnosis

Physicians usually pinch your Achilles tendon with their fingers to test for swelling and pain. If the tendon itself is inflamed, your physician may be able to feel warmth and swelling around the tissue, or, in chronic cases, lumps of scar tissue. You will probably be asked to walk around the exam room so your physician can examine your stride. To check for complete rupture of the tendon, your physician may perform the Thompson test. Your physician squeezes your calf; if your Achilles is not torn, the foot will point downward. If your Achilles is torn, the foot will remain in the same position. Should your physician require a closer look, these imaging tests may be performed. X-rays taken from different angles may be used to rule out other problems, such as ankle fractures. MRI (magnetic resonance imaging) uses magnetic waves to create pictures of your ankle that let physicians more clearly look at the tendons surrounding your ankle joint.


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.

Achilles Tendinitis


Surgical Treatment

Surgery is considered the last resort and is often performed by an orthopedic surgeon. It is only recommended if all other treatment options have failed after at least six months. In this situation, badly damaged portions of the tendon may be removed. If the tendon has ruptured, surgery is necessary to re-attach the tendon. Rehabilitation, including stretching and strength exercises, is started soon after the surgery. In most cases, normal activities can be resumed after about 10 weeks. Return to competitive sport for some people may be delayed for about three to six months.


Prevention

Appropriately warm up and stretch before practice or competition. Allow time for adequate rest and recovery between practices and competition. Maintain appropriate conditioning, Ankle and leg flexibility, Muscle strength and endurance, Cardiovascular fitness. Use proper technique. To help prevent recurrence, taping, protective strapping, or an adhesive bandage may be recommended for several weeks after healing is complete.