tendon attaches the calf muscle to the heel bone. Achilles tendonitis is a repetitive strain (overuse) injury involving lower leg muscles and tendons at the point where they attach to the bone,
resulting in pain at the back of the ankle. Chronic overuse can lead to small tears within the tendon causing long-term weakening, making the tendon susceptible to rupture, which could result in a
need for surgery.
The causes of Achilles tendonitis all appear to be related to excessive stress being transmitted through the tendon. Weak calf muscles, poor ankle range of motion, and excessive pronation have all
been connected with the development of Achilles problems.The upshot is that all of these factors, plus training volume and so on, result in damage to the tendon. Much like a bungee cord is made up of
tiny strands of rubber aligned together, tendons are comprised of small fiber-like proteins called collagen. Pain in the Achilles tendon is a result of damage to the collagen. Because of this,
treatment options should start with ways to address this.
Dull or sharp pain anywhere along the back of the tendon, but usually close to the heel. limited ankle flexibility redness or heat over the painful area a nodule (a lumpy build-up of scar tissue)
that can be felt on the tendon a cracking sound (scar tissue rubbing against tendon) with ankle movement.
When diagnosing Achilles tendinitis, a doctor will ask the patient a few questions about their symptoms and then perform a physical examination. To perform a physical exam on the Achilles tendon, the
doctor will lightly touch around the back of the ankle and tendon to locate the source of the pain or inflammation. They will also test the foot and ankle to see if their range of motion and
flexibility has been impaired. The doctor might also order an imaging test to be done on the tendon. This will aid in the elimination of other possible causes of pain and swelling, and may help the
doctor assess the level of damage (if any) that has been done to the tendon. Types of imaging tests that could be used for diagnosing Achilles tendinitis are MRI (Magnetic resonance imaging), X-ray,
Treatment options might include anti-inflammatory medication such as ibuprofen which might help with acute achilles inflammation and pain but has not been proven to be beneficial long term and may
even inhibit healing. If the injury is severe then a plaster cast might be applied to immobilize the tendon. Use of electrotherapy such as ultrasound treatment, laser therapy and extracorporeal shock
wave therapy (ESWT) may be beneficial in reducing pain and encouraging healing. Applying sports massage techniques can mobilze the tissues or the tendon itself and help stretch the calf muscles. Some
might give a steroid injection however an injection directly into the tendon is not recommended. Some specialists believe this can increase the risk of a total rupture of the tendon in future. One of
the most effective forms of treatment for achilles tendonitis is a full rehabilitation program consisting of eccentric strengthening exercises. There is now considerable evidence suggesting the
effectiveness of slow eccentric rehabilitation exercises for curing achilles tendon pain.
Surgery for an Achilles tendon rupture can be done with a single large incision, which is called open surgery. Or it can be done with several small incisions. This is called percutaneous surgery. The
differences in age and activity levels of people who get surgery can make it hard to know if Achilles tendon surgery is effective. The success of your surgery can depend on, your surgeon's
experience. The type of surgery you have. How damaged the tendon is. How soon after rupture the surgery is done. How soon you start your rehab program after surgery. How well you follow your rehab
program. Talk to your surgeon about his or her surgical experience. Ask about his or her success rate with the technique that would best treat your condition.
Regardless of whether the Achilles injury is insertional or non-insertional, a great method for lessening stress on the Achilles tendon is flexor digitorum longus exercises. This muscle, which
originates along the back of the leg and attaches to the tips of the toes, lies deep to the Achilles. It works synergistically with the soleus muscle to decelerate the forward motion of the leg
before the heel leaves the ground during propulsion. This significantly lessens strain on the Achilles tendon as it decelerates elongation of the tendon. Many foot surgeons are aware of the
connection between flexor digitorum longus and the Achilles tendon-surgical lengthening of the Achilles (which is done to treat certain congenital problems) almost always results in developing hammer
toes as flexor digitorum longus attempts to do the job of the recently lengthened tendon. Finally, avoid having cortisone injected into either the bursa or tendon-doing so weakens the tendon as it
shifts production of collagen from type one to type three. In a recent study published in the Journal of Bone Joint Surgery(9), cortisone was shown to lower the stress necessary to rupture the
Achilles tendon, and was particularly dangerous when done on both sides, as it produced a systemic effect that further weakened the tendon.