Typically an overuse injury, Achilles
tendinitis affects the connective tissue between the calf and the heel. When you walk, run or otherwise use your leg to push your body upward, the Achilles tendon is engaged. Using the tendon
frequently and with high intensity often results in tendinitis -- a swollen Achilles tendon that makes it difficult and sometimes painful to continue high-impact activities.
As ?overuse? disorders, Achilles tendonitis and tendonosis are usually caused by a sudden increase of a repetitive activity involving the Achilles tendon. Such activity puts too much stress on the
tendon too quickly, leading to micro-injury of the tendon fibers. Due to this ongoing stress on the tendon, the body is unable to repair the injured tissue. The structure of the tendon is then
altered, resulting in continued pain. Achilles4Athletes are at high risk for developing disorders of the Achilles tendon. Achilles tendonitis and tendonosis are also common in individuals whose work
puts stress on their ankles and feet, such as laborers, as well as in ?weekend warriors?-those who are less conditioned and participate in athletics only on weekends or infrequently. In addition,
people with excessive pronation (flattening of the arch) have a tendency to develop Achilles tendonitis and tendonosis due to the greater demands placed on the tendon when walking. If these
individuals wear shoes without adequate stability, their over-pronation could further aggravate the Achilles tendon.
Achilles tendinitis symptoms present as mild to severe pain or swelling near the ankle. The pain may lead to weakness and decreased mobility, symptoms that increase gradually while walking or
running. Over time, the pain worsens, and stiffness in the tendon may be noted in the morning. Mild activity may provide relief. Physical exam may reveal an audible cracking sound when the Achilles
tendon is palpated. The lower leg may exhibit weakness. A ruptured or torn Achilles tendon is severely painful and warrants immediate medical attention. The signs of a ruptured or torn Achilles
tendon include. Acute, excruciating pain. Impaired mobility, unable to point the foot downward or walk on the toes. Weight bearing or walking on the affected side is not possible.
A doctor examines the patient, checking for pain and swelling along the posterior of the leg. The doctor interviews the patient regarding the onset, history, and description of pain and weakness. The
muscles, tissues, bones, and blood vessels may be evaluated with imaging studies, such as X-ray, ultrasound, or MRI.
Treatment approaches for Achilles tendonitis or tendonosis are selected on the basis of how long the injury has been present and the degree of damage to the tendon. In the early stage, when there is
sudden (acute) inflammation, one or more of the following options may be recommended. Immobilization. Immobilization may involve the use of a cast or removable walking boot to reduce forces through
the Achilles tendon and promote healing. Ice. To reduce swelling due to inflammation, apply a bag of ice over a thin towel to the affected area for 20 minutes of each waking hour. Do not put ice
directly against the skin. Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation in the early stage of the
condition. Orthotics. For those with over-pronation or gait abnormalities, custom orthotic devices may be prescribed. Night splints. Night splints help to maintain a stretch in the Achilles tendon
during sleep. Physical therapy. Physical therapy may include strengthening exercises, soft-tissue massage/mobilization, gait and running re-education, stretching, and ultrasound therapy.
Chronic Achilles tendon tears can be more complicated to repair. A tendon that has torn and retracted (pulled back) into the leg will scar in the shortened position over time. Restoring normal tendon
length is usually not an issue when surgery is performed within a few weeks of the injury. However, when there has been a delay of months or longer, the treatment can be more complicated. Several
procedures can be used to add length to a chronic Achilles tear. A turndown procedure uses tissue folded down from the top of the calf to add length to the Achilles tendon. Tendon transfers from
other tendons of the ankle can also be performed to help restore function of the Achilles. The results of surgery in a chronic situation are seldom as good as an acute repair. However, in some
patients, these procedures can help restore function of a chronically damaged Achilles.
Your podiatrist will work with you to decrease your chances of re-developing tendinitis. He or she may create custom orthotics to help control the motion of your feet. He or she may also recommend
certain stretches or exercises to increase the tendon's elasticity and strengthen the muscles attached to the tendon. Gradually increasing your activity level with an appropriate training
schedule-building up to a 5K run, for instance, instead of simply tackling the whole course the first day-can also help prevent tendinitis.