It is a condition that I see often enough. With persons into fitness, the hardest thing for them to hear, is to rest for proper recovery. The Achilles tendon joins the calf muscles to the heel bone, and runs down the back of the lower leg. When this tendon is put under excess strain, it can become inflamed. This is Achilles tendonitis. The Achilles tendon is the largest tendon in the body. It can endure great force, but it is still susceptible to injury. Achilles tendonitis, or tendinosis, usually results from microtears that occur in the tendon, during strenuous, high impact exercise, such as running.

Symptoms

The main symptom of Achilles tendonitis is a gradual build-up of pain, that worsens with time. The individual may also notice the following:

• The tendon feels sore a few centimetres above where it meets the heel bone.
• The lower leg feels stiff, slow, or weak.
• A slight pain appears in the back of the leg, after running or exercising, and becomes more severe.
• Pain in the tendon occurs while running, or a couple of hours after.
• Pain is greater when running fast, for a long time, or when climbing stairs.
• It swells or forms a bump.
• It creaks when touched or moved.

Causes

Tendinitis can develop in different ways. Some are easier to avoid than others, but being aware of them, can aid earlier diagnosis, and help prevent serious injury.
Non-insertional Achilles tendonitis is more common in younger, more active people. The fibres in the middle of the tendon, start to break down, thicken, and swell. Insertional tendonitis is not necessarily related to activity. However, it affects the lower portion of the tendon, as it inserts into the heel bone.

The causes include:

•  using incorrect or worn out shoes, when running or exercising.
• not warming up properly before exercise.
•  increasing intensity of exercise too quickly; for example, running speed, or distance covered.
•  prematurely introducing hill running, or stair climbing, to an exercise routine.
•  running on hard or uneven surfaces.
• when the calf muscle is injured or has little flexibility, which puts more strain on the tendon.
• sudden intense physical activity, such as sprinting for the finish line
• differences in foot, leg, or ankle anatomy.
• flat feet or fallen arches, which can strain the tendon.
• bone spurs (extra bone growths), where the tendon joins the bone. These can rub against the tendon, causing damage and discomfort.

Diagnosis

These and other similar symptoms feature in a number of conditions, so medical advice is needed for an accurate diagnosis. A doctor or podiatrist will ask about symptoms, and perform a physical examination. They will lightly touch the back of the ankle and tendon, to locate the source of the pain, or inflammation. The doctor or podiatrist will also test the foot and ankle, to see if the range of motion and flexibility, are impaired.
An imaging test, for example, an x-ray, MRI, or ultrasound scan, can help to eliminate other possible causes of pain and swelling, along with assessing any damage to the tendon.

Possible complications

Achilles tendonitis, can lead to Achilles tendinosis, a degenerative condition in which the structure of the tendon changes, and becomes susceptible to serious damage. The tendon can tear, causing great pain. Tendonitis and tendinosis are different conditions. Tendonitis involves inflammation, while tendinosis is a degenerative process on a cellular level, and there is no inflammation. Tendinosis is often misdiagnosed as tendonitis. So getting the correct diagnosis, will lead to more appropriate treatment.

 Treatment

Treatment may involve physical therapy. The aim is to relieve pain, and reduce swelling. The choice of treatment, will depend on the severity of the condition, and whether the patient is a professional athlete or not. The doctor or podiatrist will probably suggest a combination of strategies.

Methods of treatment include:

• RICE – Rest, Ice, Compress, Elevate
• Pain relief – Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, can reduce pain and swelling.
• Steroid injections – Cortisone, for example, can reduce tendon swelling, but it has also been associated with a greater risk of tendon rupture. Giving the injection while scanning the area with ultrasound, can reduce this risk.
• Compression bandages and orthotic devices: Ankle supports and shoe inserts can aid recovery, as they take the stress off the tendon.
  
• Heel lifts, which move the foot away from the back of the shoe, may help patients with insertional Achilles tendonitis.
  It usually takes between a few days to six weeks for tendonitis to heal. Untreated, the tendon can become torn or ruptured. In mild cases, treatment may involve resting, or changing an exercise routine, but more severe cases may need surgery.

 

              Your feet mirror your general health . . . cherish them!