Regarding Achilles Tendonitis

Overview

Achilles TendonThe Achilles tendon is the largest tendon in the body. Tendons are long, tough cords of tissue that connect muscle to bone. The Achilles tendon is located in the back of the foot and connects your heel bone to your calf muscle. It helps you to walk, run and jump. The Achilles tendon is able to endure stress, but sometimes injury can occur to the tendon when overly stressed. Overuse of the Achilles tendon may cause the tendon to swell, become irritated, inflamed and cause pain. This is Achilles tendinitis. It is a common sports injury related to running, but can happen to anyone who puts a lot of stress on their feet (e.g.: basketball players and dancers). If you do not get treatment for Achilles tendinitis, the problem can become chronic and make it difficult for you to walk.




Causes

The cause of paratenonitis is not well understood although there is a correlation with a recent increase in the intensity of running or jumping workouts. It can be associated with repetitive activities which overload the tendon structure, postural problems such as flatfoot or high-arched foot, or footwear and training issues such as running on uneven or excessively hard ground or running on slanted surfaces. Tendinosis is also associated with the aging process.




Symptoms

The pain associated with Achilles tendonitis can come on gradually or be caused by some type of leg or foot trauma. The pain can be a shooting, burning, or a dull ache. You can experience the pain at either the insertion point on the back of the heel or upwards on the Achilles tendon within a few inches. Swelling is also common along the area with the pain. The onset of discomfort at the insertion can cause a bump to occur called a Haglund's deformities or Pump bump. This can be inflammation in the bursa sac that surrounds the insertion of the Achilles tendon, scar tissue from continuous tares of the tendon, or even some calcium buildup. In this situation the wearing of closed back shoes could irritate the bump. In the event of a rupture, which is rare, the foot will not be able to go through the final stage of push off causing instability. Finally, you may experience discomfort, even cramping in the calf muscle.




Diagnosis

On examination, an inflamed or partially torn Achilles tendon is tender when squeezed between the fingers. Complete tears are differentiated by sudden, severe pain and inability to walk on the extremity. A palpable defect along the course of the tendon. A positive Thompson test (while the patient lies prone on the examination table, the examiner squeezes the calf muscle; this maneuver by the examiner does not cause the normally expected plantar flexion of the foot).




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 Tendonitis




Surgical Treatment

Most people will improve with simple measures or physiotherapy. A small number continue to have major problems which interfere with their lifestyle. In this situation an operation may be considered. If an operation is being considered, the surgeon will interview you and examine you again and may want you to have further treatment before making a decision about an operation. Before undergoing Achilles tendonitis surgery, London based patients, and those who can travel, will be advised to undergo a scan, which will reveal whether there is a problem in the tendon which can be corrected by surgery. Patients will also have the opportunity to ask any questions and raise any concerns that they may have, so that they can proceed with the treatment with peace of mind.




Prevention

Wear shoes that fit correctly and support your feet: Replace your running or exercise shoes before the padding or shock absorption wears out. Shock absorption greatly decreases as the treads on the bottoms or sides of your shoes begin to wear down. You may need running shoes that give your foot more heel or arch support. You may need shoe inserts to keep your foot from rolling inward. Stretch before you exercise: Always warm up your muscles and stretch gently before you exercise. Do cool down exercises when you are finished. This will loosen your muscles and decrease stress on your Achilles tendon. Exercise the right way: If your tendinitis is caused by the way that you exercise, ask a trainer, coach, or your caregiver for help. They can teach you ways to train or exercise to help prevent Achilles tendinitis. Do not run or exercise on uneven or hard surfaces. Instead, run on softer surfaces such as treadmills, rubber tracks, grass, or evenly packed dirt tracks.

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