Achilles Tendonitis

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Overview

Achilles TendonAchilles tendinitis describes an inflammatory change of the Achilles tendon without a tear of the tendon. Achilles tendinitis may be acute or chronic. The onset of pain is usually unilateral but may be found bilaterally. Achilles tendinitis is common in the third or fourth decade of life in patients who are active with sports or in jobs that require physical labor. Pain is described at the insertion of the tendon in the heel bone or in the body of the tendon.

Causes

There are a number of ways a person can develop Achilles tendinitis. Some causes are easier to avoid than others, but being aware of them can aid earlier diagnosis and help prevent serious injury. Causes of Achilles tendinitis include, using incorrect or worn out shoes when running or exercising. Not warming up properly before exercise. Increasing intensity of exercise too quickly (e.g. running speed or distance covered). Prematurely introducing hill running or stair climbing to exercise routine. Running on hard or uneven surfaces. Calf muscle is injured or has little flexibility (this puts a lot of strain on the Achilles tendon). Sudden intense physical activity such as sprinting for the finish line. Achilles tendinitis can also be caused by differences in foot, leg or ankle anatomy. For example, some people can have flatness in their foot where there would normally be an arch; this puts more strain on the tendon. The FDA has asked that a boxed warning be added to the prescribing information for fluoroquinolone antibiotics. Patients taking these drugs may experience an increased risk of tendinitis and tendon rupture. Fluoroquinolones include Cipro (ciprofloxacin), Factive (gemifloxacin), Levaquin (levofloxacin), Avelox (moxifloxacin), Noroxin (norfloxacin), Floxin (ofloxacin) and Proquin (ciprofloxacin hydrochloride). It is important to remember that the risk for injury is not necessarily gone when the drug is stopped. Cases have been reported in which tendon problems occurred up to several months after the drug was discontinued.

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

During the physical exam, your doctor will gently press on the affected area to determine the location of pain, tenderness or swelling. He or she will also evaluate the flexibility, alignment, range of motion and reflexes of your foot and ankle. Your doctor may order one or more of the following tests to assess your condition, X-rays. While X-rays can't visualize soft tissues such as tendons, they may help rule out other conditions that can cause similar symptoms. Ultrasound. This device uses sound waves to visualize soft tissues like tendons. Ultrasound can also produce real-time images of the Achilles tendon in motion. Magnetic resonance imaging (MRI). Using radio waves and a very strong magnet, MRI machines can produce very detailed images of the Achilles tendon.

Nonsurgical Treatment

Most cases are successfully treated non-surgically although this is time-consuming and frustrating for active patients. Treatment is less likely to be successful if symptoms have been present more than six months. Nonsurgical management includes nonsteroidal anti-inflammatory medications, rest, immobilization, limitation of activity, ice, contrast baths, stretching and heel lifts. If symptoms fail to resolve after two to three months, a formal physical therapy program may be of benefit. An arch support may help if there is an associated flatfoot. A cast or brace to completely rest this area may be necessary. Extracorporeal shockwave therapy and platelet-rich plasma injections? have variable reports of success. Nitroglycerin medication applied to the overlying skin may be of benefit.

Achilles Tendonitis

Surgical Treatment

Around 1 in 4 people who have persisting pain due to Achilles tendinopathy has surgery to treat the condition. Most people have a good result from surgery and their pain is relieved. Surgery involves either of the following, removing nodules or adhesions (parts of the fibres of the tendon that have stuck together) that have developed within the damaged tendon. Making a lengthways cut in the tendon to help to stimulate and encourage tendon healing. Complications from surgery are not common but, if they do occur, can include problems with wound healing.

Prevention

Achilles tendinitis cannot always be prevented but the following tips will help you reduce your risk. If you are new to a sport, gradually ramp up your activity level to your desired intensity and duration. If you experience pain while exercising, stop. Avoid strenuous activity that puts excessive stress on your Achilles tendon. If you have a demanding workout planned, warm up slowly and thoroughly. Always exercise in shoes that are in good condition and appropriate for your activity or sport. Be sure to stretch your calf muscles and Achilles tendon before and after working out. If you suffer from Achilles tendinitis make sure you treat it properly and promptly. If self-care techniques don?t work, don?t delay. Book a consultation with a foot care expert or you may find yourself sidelined from your favourite sports and activities.
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