Achilles tendinitis is a common condition that causes pain on the back of the leg near the heel. The achilles tendon is the largest tendon in the body connecting your calf muscles to your heel bone. Your achilles tendon is used when you walk, run or jump. It is made to withstand a high amount of stress from these activities, but when it is overused, you can develop tendinitis. Tendinitis is defined as inflammation of a tendon. When you are injured, your body’s natural response causes inflammation. You may experience pain, swelling, or tenderness at the injured site. There are two types of achilles tendinitis, insertional and non-insertional achilles tendinitis.
Tight or fatigued calf muscles, which transfer the burden of running to the Achilles. This can be due to poor stretching, rapidly increasing distance, or over-training excessive hill running or speed work, both of which stress the Achilles more than other types of running. Inflexible running shoes, which, in some cases, may force the Achilles to twist. Runners who overpronate (feet rotate too far inward on impact) are most susceptible to Achilles tendinitis.
Symptoms of Achilles Tendinitis include the following. Pain and stiffness along the Achilles tendon in the morning. Pain along the tendon or back of the heel that worsens with activity. Severe pain the day after exercising. Thickening of the tendon. Bone spur (insertional tendinitis). Swelling that is present all the time and gets worse throughout the day with activity. If you have an Achilles tendon rupture, you might feel a pop or snap, accompanied by a sharp pain behind your ankle. You are likely to have difficulty walking properly. If you have ruptured your Achilles tendon then surgery is likely to be the best treatment option.
A doctor or professional therapist will confirm a diagnosis, identify and correct possible causes, apply treatment and prescribe eccentric rehabilitation exercises. An MRI or Ultrasound scan can determine the extent of the injury and indicate a precise diagnosis. Gait analysis along with a physical assessment will identify any possible biomechanical factors such as over pronation which may have contributed to the achilles tendonitis and training methods will be considered. Biomechanical problems can be corrected with the use of orthotic inserts and selection of correct footwear.
The recommended treatment for Achilles tendinitis consists of icing, gentle stretching, and modifying or limiting activity. Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen or aspirin, can reduce pain and swelling. Physical therapy and the use of an orthotic (heel lift) can also be helpful. For chronic cases where tendinosis is evident and other methods of treatment have failed, surgery may be recommended to remove and repair the damaged tissue.
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.
Although Achilles tendinitis cannot be completely prevented, the risk of developing it can be lowered. Being aware of the possible causes does help, but the risk can be greatly reduced by taking the following precautions. Getting a variety of exercise – alternating between high-impact exercises (e.g. running) and low-impact exercise (e.g. swimming) can help, as it means there are days when the Achilles tendon is under less tension. Limit certain exercises – doing too much hill running, for example, can put excessive strain on the Achilles tendon. Wearing the correct shoes and replacing them when worn – making sure they support the arch and protect the heel will create less tension in the tendon. Using arch supports inside the shoe, if the shoe is in good condition but doesn’t provide the required arch support this is a cheaper (and possibly more effective) alternative to replacing the shoe completely. Stretching, doing this before and after exercising helps to keep the Achilles tendon flexible, which means less chance of tendinitis developing. There is no harm in stretching every day (even on days of rest), as this will only further improve flexibility. Gradually increasing the intensity of a workout – Achilles tendinitis can occur when the tendon is suddenly put under too much strain, warming up and increasing the level of activity gradually gives your muscles time to loosen up and puts less pressure on the tendon.