tendinitis is an overuse injury of the Achilles tendon, the band of tissue that connects calf muscles at the back of the lower leg to your heel bone. 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 surgical repair.
Short of a trauma, the primary cause of Achilles tendonitis is when the calf muscle is so tight that the heel is unable to come down to the ground placing extreme stress on the Achilles tendon at the
insertion. Keep in mind that the calf muscle is designed to contract up, lifting the heel bone off the ground, propelling you forwards to the front of the foot for push off. When the calf is so tight
that the heel is prevented from coming down on the ground there will be stress on the tendon and the foot will over pronate causing the Achilles tendon to twist, adding to the stress on the
insertion. Improper treatment may lead to a more severe injury, such as a rupture or chronic weakening, which may require surgery.
Gradual onset of pain and stiffness over the tendon, which may improve with heat or walking and worsen with strenuous activity. Tenderness of the tendon on palpation. There may also be crepitus and
swelling. Pain on active movement of the ankle joint. Ultrasound or MRI may be necessary to differentiate tendonitis from a partial tendon rupture.
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,
Treatment will depend on the severity of the injury. In general terms, the longer the symptoms are present before treatment begins, the longer the timeframe until complete recovery is achieved.
Complete recovery can take between three and nine months. Initial treatment of Achilles tendonitis includes, Rest, to avoid further injury to the area. Ice, to reduce inflammation, Elevation, to
reduce swelling. Bandaging or strapping, to support the area and restrict movement of the tendon. Anti-inflammatory medications to reduce pain and inflammation. (Cortisone (steroid) injections to
reduce inflammation are not usually recommended as they may weaken the tendon and increase the risk of rupture). Other treatments include, Physiotherapy, Physiotherapy plays an important role in the
treatment of Achilles tendonitis. This generally focuses on two main areas - treatment and rehabilitation. Treatment may involve such techniques as massage, ultrasound, acupuncture and gentle
stretching. Rehabilitation involves the development of an individualised recovery programme, the most important aspect of which is strengthening. Strengthening of the muscles surrounding the Achilles
tendon helps to promote healing in the tendon itself. Strengthening is achieved through the use of specific exercises, which will be taught by the physiotherapist. One such exercise is eccentric
loading, which involves contracting the calf muscle while it is being stretched. It is common for the rehabilitation programme to take up to three months. Podiatry, including gait analysis and the
fitting of orthotic devices to support the foot and reduce stress on the tendon, may be recommended. For cases of Achilles tendonitis that do not respond to initial treatment, casting or splinting of
the affected foot may be recommended to allow it to rest completely.
The type of surgery you will have depends on the type of injury you are faced with. The longer you have waited to have surgery will also be a factor that determines what type of surgery is needed.
With acute (recent) tearing the separation in your Achilles tendon is likely to be very minimal. If you have an acute tear you may qualify for less invasive surgery (such as a mini-open procedure).
Surgeons will always choose a shorter, less invasive procedure if it is possible to do so. Most surgeons know that a less complicated procedure will have less trauma to the tendon and a much quicker
rate of recovery after the surgery.
The following measures can significantly reduce the risk of developing Achilles tendonitis. Adequately stretch and warm up prior to exercise. Warm down and stretch after exercise. Choose footwear
carefully and use footwear appropriate to the sport being undertaken. Use orthotic devices in footwear to correctly support the foot. Exercise within fitness levels and follow a sensible exercise
programme. Develop strong, flexible calf muscles.