What Are The Main Causes And Treatment Of Achilles Tendonitis ?

Overview

Achilles TendinitisThe Achilles is a large tendon that connects two major calf muscles to the back of the heel bone. If this tendon is overworked and tightens, the collagen fibres of the tendon may break, causing inflammation and pain. This can result in scar tissue formation, a type of tissue that does not have the flexibility of tendon tissue. Four types of Achilles injuries exist, 1) Paratendonitis - involves a crackly or crepitus feeling in the tissues surrounding the Achilles tendon. 2) Proliferative Tendinitis - the Achilles tendon thickens as a result of high tension placed on it. 3) Degenerative Tendinitis - a chronic condition where the Achilles tendon is permanently damaged and does not regain its structure. 4) Enthesis - an inflammation at the point where the Achilles tendon inserts into the heel bone.

Causes

Some of the causes of Achilles tendonitis include, overuse injury - this occurs when the Achilles tendon is stressed until it develops small tears. Runners seem to be the most susceptible. People who play sports that involve jumping, such as basketball, are also at increased risk. Arthritis - Achilles tendonitis can be a part of generalised inflammatory arthritis, such as ankylosing spondylitis or psoriatic arthritis. In these conditions, both tendons can be affected. Foot problems - some people with flat feet or hyperpronated feet (feet that turn inward while walking) are prone to Achilles tendonitis. The flattened arch pulls on calf muscles and keeps the Achilles tendon under tight strain. This constant mechanical stress on the heel and tendon can cause inflammation, pain and swelling of the tendon. Being overweight can make the problem worse. Footwear - wearing shoes with minimal support while walking or running can increase the risk, as can wearing high heels. Overweight and obesity - being overweight places more strain on many parts of the body, including the Achilles tendon. Quinolone antibiotics - can in some instances be associated with inflammatory tenosynovitis and, if present, will often be bilateral (both Achilles), coming on soon after exposure to the drug.

Symptoms

Achilles tendonitis is an injury that occurs when your Achilles tendon -- the large band of tissues connecting the muscles in the back of your lower leg to your heel bone -- becomes inflamed or irritated. The signs and symptoms of Achilles tendonitis often develop gradually. You'll feel pain and stiffness in your Achilles, especially when you first get out of bed. The pain lessens as you warm up, and may even disappear as you continue running. Once you stop, the pain returns and may feel even worse. You may also notice a crackling or creaking sound when you touch or move your Achilles tendon.

Diagnosis

There is enlargement and warmth of the tendon 1 to 4 inches above its heel insertion. Pain and sometimes a scratching feeling may be created by gently squeezing the tendon between the thumb and forefinger during ankle motion. There may be weakness in push-off strength with walking. Magnetic resonance imaging (MRI) can define the extent of degeneration, the degree to which the tendon sheath is involved and the presence of other problems in this area, but the diagnosis is mostly clinical.

Nonsurgical Treatment

Physical therapy is the first and most useful defense for achilles tendonitis because of the two presentations outlined above. Treatments for the two types are quite different in approach. Midsubstance tendinitis responds well to stretching, whereas insertional tendnitis tends to be aggravated more by it. Depend on your trusted physical therapist to differentiate between the two and follow their guidelines on exercises and running modifications. Running gait patterns that show excessive ?sinking postures? tend to point to the source of achilles tendon problems. Altering your gait in the midstance phase of the cycle can reduce the load on the tendon dramatically and thereby reduce pain. Rely on your running physical therapist for proper guidance on altering your gait the right way. Stride Strong?s Portland Running Clinic gait analysis can identify and fix potential issues before pain sets in. Icing at the onset of acute achilles pain (i.e. when the injury is fresh and new) would help control the inflammation. Your next step should be to call our number for an appointment.

Achilles Tendon

Surgical Treatment

There are two types of Achilles repair surgery for tendonitis (inflammation of the Achilles Tendon), if nonsurgical treatments aren't effective. Gastrocnemius recession - The orthopaedic surgeon lengthens the calf muscles to reduce stress on your Achilles tendon. D?bridement and repair - During this procedure, the surgeon removes the damaged part of the Achilles tendon and repairs the remaining tendon with sutures or stitches. Debridement is done when the tendon has less than 50% damage.

Prevention

A 2014 study looked at the effect of using foot orthotics on the Achilles tendon. The researchers found that running with foot orthotics resulted in a significant decrease in Achilles tendon load compared to running without orthotics. This study indicates that foot orthoses may act to reduce the incidence of chronic Achilles tendon pathologies in runners by reducing stress on the Achilles tendon1. Orthotics seem to reduce load on the Achilles tendon by reducing excessive pronation,

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