Overview
Achilles tendinitis is an overuse injury common in many sports that require lots of running and jumping. Once this condition becomes more chronic adhesions that form along the tissues and the injury becomes more of a tendinosis. Treatment for a tendinosis is much different that for a tendinitis, so it is important to recognize what stage the injury is at in order to treat it appropriately. An acute achilles tendinitis involves inflammation and would be treated with rest, ice, etc. Once the inflammation has decreased, research shows that eccentric exercises are beneficial. Once there is tendinosis, it becomes imperative to break up those adhesions with ART and prescribe appropriate stretches and exercises.
Causes
Achilles tendinitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too soon, but other factors can make it more likely to develop tendinitis, including a bone spur that has developed where the tendon attaches to the heel bone, Sudden increase in the amount or intensity of exercise activity-for example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance, Tight calf muscles, Having tight calf muscles and suddenly starting an aggressive exercise program can put extra stress on the Achilles tendon, Bone spur-Extra bone growth where the Achilles tendon attaches to the heel bone can rub against the tendon and cause pain.
Symptoms
The main complaint associated with Achilles tendonitis is pain behind the heel. The pain is often most prominent in an area about 2-4 centimeters above where the tendon attaches to the heel. In this location, called the watershed zone of the tendon, the blood supply to the tendon makes this area particularly susceptible. Patients with Achilles tendonitis usually experience the most significant pain after periods of inactivity. Therefore patients tend to experience pain after first walking in the morning and when getting up after sitting for long periods of time. Patients will also experience pain while participating in activities, such as when running or jumping. Achilles tendonitis pain associated with exercise is most significant when pushing off or jumping.
Diagnosis
The doctor will perform a physical exam. The doctor will look for tenderness along the tendon and pain in the area of the tendon when you stand on your toes. X-rays can help diagnose bone problems. An MRI scan may be done if your doctor is thinking about surgery or is worried about the tear in the Achilles tendon.
Nonsurgical Treatment
Self-care strategies include the following steps, often known by the acronym R.I.C.E, Rest. You may need to avoid exercise for several days or switch to an activity that doesn't strain the Achilles tendon, such as swimming. In severe cases, you may need to wear a walking boot and use crutches. Ice. To decrease pain or swelling, apply an ice pack to the tendon for about 15 minutes after exercising or when you experience pain. Compression. Wraps or compressive elastic bandages can help reduce swelling and reduce movement of the tendon. Elevation. Raise the affected foot above the level of your heart to reduce swelling. Sleep with your affected foot elevated at night.
Surgical Treatment
Surgery usually isn't needed to treat Achilles tendinopathy. But in rare cases, someone might consider surgery when rubbing between the tendon and the tissue covering the tendon (tendon sheath) causes the sheath to become thick and fibrous. Surgery can be done to remove the fibrous tissue and repair any small tendon tears. This may also help prevent an Achilles tendon rupture.
Prevention
While it may not be possible to prevent Achilles tendinitis, you can take measures to reduce your risk. Increase your activity level gradually. If you're just beginning an exercise regimen, start slowly and gradually increase the duration and intensity of the training. Take it easy. Avoid activities that place excessive stress on your tendons, such as hill running. If you participate in a strenuous activity, warm up first by exercising at a slower pace. If you notice pain during a particular exercise, stop and rest. Choose your shoes carefully. The shoes you wear while exercising should provide adequate cushioning for your heel and should have a firm arch support to help reduce the tension in the Achilles tendon. Replace your worn-out shoes. If your shoes are in good condition but don't support your feet, try arch supports in both shoes. Stretch daily. Take the time to stretch your calf muscles and Achilles tendon in the morning, before exercise and after exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendinitis. Strengthen your calf muscles. Strong calf muscles enable the calf and Achilles tendon to better handle the stresses they encounter with activity and exercise. Cross-train. Alternate high-impact activities, such as running and jumping, with low-impact activities, such as cycling and swimming.
Achilles tendinitis is an overuse injury common in many sports that require lots of running and jumping. Once this condition becomes more chronic adhesions that form along the tissues and the injury becomes more of a tendinosis. Treatment for a tendinosis is much different that for a tendinitis, so it is important to recognize what stage the injury is at in order to treat it appropriately. An acute achilles tendinitis involves inflammation and would be treated with rest, ice, etc. Once the inflammation has decreased, research shows that eccentric exercises are beneficial. Once there is tendinosis, it becomes imperative to break up those adhesions with ART and prescribe appropriate stretches and exercises.
Causes
Achilles tendinitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too soon, but other factors can make it more likely to develop tendinitis, including a bone spur that has developed where the tendon attaches to the heel bone, Sudden increase in the amount or intensity of exercise activity-for example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance, Tight calf muscles, Having tight calf muscles and suddenly starting an aggressive exercise program can put extra stress on the Achilles tendon, Bone spur-Extra bone growth where the Achilles tendon attaches to the heel bone can rub against the tendon and cause pain.
Symptoms
The main complaint associated with Achilles tendonitis is pain behind the heel. The pain is often most prominent in an area about 2-4 centimeters above where the tendon attaches to the heel. In this location, called the watershed zone of the tendon, the blood supply to the tendon makes this area particularly susceptible. Patients with Achilles tendonitis usually experience the most significant pain after periods of inactivity. Therefore patients tend to experience pain after first walking in the morning and when getting up after sitting for long periods of time. Patients will also experience pain while participating in activities, such as when running or jumping. Achilles tendonitis pain associated with exercise is most significant when pushing off or jumping.
Diagnosis
The doctor will perform a physical exam. The doctor will look for tenderness along the tendon and pain in the area of the tendon when you stand on your toes. X-rays can help diagnose bone problems. An MRI scan may be done if your doctor is thinking about surgery or is worried about the tear in the Achilles tendon.
Nonsurgical Treatment
Self-care strategies include the following steps, often known by the acronym R.I.C.E, Rest. You may need to avoid exercise for several days or switch to an activity that doesn't strain the Achilles tendon, such as swimming. In severe cases, you may need to wear a walking boot and use crutches. Ice. To decrease pain or swelling, apply an ice pack to the tendon for about 15 minutes after exercising or when you experience pain. Compression. Wraps or compressive elastic bandages can help reduce swelling and reduce movement of the tendon. Elevation. Raise the affected foot above the level of your heart to reduce swelling. Sleep with your affected foot elevated at night.
Surgical Treatment
Surgery usually isn't needed to treat Achilles tendinopathy. But in rare cases, someone might consider surgery when rubbing between the tendon and the tissue covering the tendon (tendon sheath) causes the sheath to become thick and fibrous. Surgery can be done to remove the fibrous tissue and repair any small tendon tears. This may also help prevent an Achilles tendon rupture.
Prevention
While it may not be possible to prevent Achilles tendinitis, you can take measures to reduce your risk. Increase your activity level gradually. If you're just beginning an exercise regimen, start slowly and gradually increase the duration and intensity of the training. Take it easy. Avoid activities that place excessive stress on your tendons, such as hill running. If you participate in a strenuous activity, warm up first by exercising at a slower pace. If you notice pain during a particular exercise, stop and rest. Choose your shoes carefully. The shoes you wear while exercising should provide adequate cushioning for your heel and should have a firm arch support to help reduce the tension in the Achilles tendon. Replace your worn-out shoes. If your shoes are in good condition but don't support your feet, try arch supports in both shoes. Stretch daily. Take the time to stretch your calf muscles and Achilles tendon in the morning, before exercise and after exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendinitis. Strengthen your calf muscles. Strong calf muscles enable the calf and Achilles tendon to better handle the stresses they encounter with activity and exercise. Cross-train. Alternate high-impact activities, such as running and jumping, with low-impact activities, such as cycling and swimming.