Regarding Achilles Tendinitis

Overview

Achilles TendonThe Achilles tendon connects the calf muscle to the back of the heel. Injuries to the Achilles tendon are common, as it is in constant use during walking and running. These injuries, known as Achilles tendinitis, are usually the result of overuse damage and minor tears that have accumulated over years. Your risk of developing Achilles tendinitis increases with age and activity level. Many athletes develop Achilles tendinitis. The tendon may be injured several inches away from where it attaches to the foot or at the point of attachment. An injury at the point of attachment is called Achilles enthesopathy. We recommend a combination of treatments over a period of months that may include wearing supportive shoes or orthotic devices, performing stretching exercises, and icing the affected area. If these treatments are not effective, or if the tendon is completely torn, we may recommend surgery.


Causes

Like any muscle or tendon in the body, the older we get, the more likely we are to sustain an injury. So middle-aged men and women are most at risk, with a slightly higher risk factor attributed to males. Those who participate in more intense athletic activities like high impact sports (tennis, running, basketball) are most susceptible to the injury. Certain underlying medical conditions can also be a contributing factor. Diabetics are more at risk of suffering from Achilles Tendinitis, as are those who are not in great physical shape. Some antibiotics, particularly fluoroquinolones can make one more likely to suffer a strained Achilles Tendon.


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

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

Achilles tendinitis can typically be treated at home by following the R.I.C.E. treatment method. Rest. Rest the tendon by avoiding activities that irritate the tendon or increase swelling. However, this does not mean you should be completely inactive for long periods of time, as this can cause stiffness in your joints. It?s still important to stretch in order to maintain strength and flexibility and partake in activities that don?t put direct pressure on the tendon, such as bicycling. Ice. Apply ice to the affected area for 20-minutes at a time, every couple hours, as needed, to reduce swelling and pain. Compression. Use compression bandages to help reduce swelling. Elevation. Elevate your ankle above the level of your heart to help reduce swelling. It is particularly important to do this at night while you sleep. Simply place a pillow or two under your ankle to keep it elevated. Once the tendon has healed, be sure to gradually return to more strenuous activities. If flattened arches contributed to the injury, wear shoes with appropriate support or inserts to prevent the condition from progressing or recurring. If these non-surgical treatments have not been able to provide relief of symptoms after several months, surgery may be performed to remove inflamed tissue. However, this is not usually recommended unless all other options have been exhausted. Consult your doctor for more information about surgical treatment options.

Achilles Tendinitis


Surgical Treatment

Following the MRI or ultrasound scan of the Achilles tendon the extent of the degenerative change would have been defined. The two main types of operation for Achilles tendinosis are either a stripping of the outer sheath (paratenon) and longitudinal incisions into the tendon (known as a debridement) or a major excision of large portions of the tendon, the defects thus created then being reconstructed using either allograft (donor tendon, such as Wright medical graft jacket) or more commonly using a flexor hallucis longus tendon transfer. In cases of Achilles tendonosis with more minor degrees of degenerative change the areas can be stimulated to repair itself by incising the tendon, in the line of the fibres, which stimulates an ingrowth of blood vessels and results in the healing response. With severe Achilles tendonosis, occasionally a large area of painful tendon needs to be excised which then produces a defect which requires filling. This is best done by transferring the flexor hallucis longus muscle belly and tendon, which lies adjacent to the Achilles tendon. This results in a composite/double tendon after the operation, with little deficit from the transferred tendon.


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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