Achilles tendon is the largest tendon in the body. It is formed by the merging together of the upper calf muscles and inserts into the back of the heel bone. Its blood supply comes from the muscles
above and the bony attachment below. The blood supply is limited at the ?watershed? zone approximately 1 to 4 inches above the insertion into the heel bone. Paratendonitis and tendinosis develop in
the same area. Achilles tendinitis implies an inflammatory response, but this is very limited because there is little blood supply to the Achilles tendon. More appropriate descriptions are
inflammation of the surrounding sheath (paratenonitis), degeneration within the substance of the tendon (tendinosis) or a combination of the two.
Possible factors leading to the development of Achilles tendonitis include the following. Implementing a new exercise regiment such as running uphill or climbing stairs. Change in exercise routine,
boosting intensity or increasing duration. Shoes worn during exercise lack support, either because the soles are worn out or poor shoe design. Omitting proper warm-up prior to strenuous exercise.
Running on a hard or uneven surface. Deformation in foot such as a flat arch, or any anatomic variation that puts unnecessary strain on the Achilles tendon.
People with Achilles tendinitis may experience pain during and after exercising. Running and jumping activities become painful and difficult. Symptoms include stiffness and pain in the back of the
ankle when pushing off the ball of the foot. For patients with chronic tendinitis (longer than six weeks), x-rays may reveal calcification (hardening of the tissue) in the tendon. Chronic tendinitis
can result in a breakdown of the tendon, or tendinosis, which weakens the tendon and may cause a rupture.
Studies such as x-rays and MRIs are not usually needed to make the diagnosis of tendonitis. While they are not needed for diagnosis of tendonitis, x-rays may be performed to ensure there is no other
problem, such as a fracture, that could be causing the symptoms of pain and swelling. X-rays may show evidence of swelling around the tendon. MRIs are also good tests identify swelling, and will show
evidence of tendonitis. However, these tests are not usually needed to confirm the diagnosis; MRIs are usually only performed if there is a suspicion of another problem that could be causing the
symptoms. Once the diagnosis of tendonitis is confirmed, the next step is to proceed with appropriate treatment. Treatment depends on the specific type of tendonitis. Once the specific diagnosis is
confirmed, the appropriate treatment of tendonitis can be initiated.
Achilles tendinitis can typically be treated at home by following the R.I.C.E. treatment method. Rest. Rest the tendon by avoiding activities that irritate the tendon or increase swelling. However,
this does not mean you should be completely inactive for long periods of time, as this can cause stiffness in your joints. It?s still important to stretch in order to maintain strength and
flexibility and partake in activities that don?t put direct pressure on the tendon, such as bicycling. Ice. Apply ice to the affected area for 20-minutes at a time, every couple hours, as needed, to
reduce swelling and pain. Compression. Use compression bandages to help reduce swelling. Elevation. Elevate your ankle above the level of your heart to help reduce swelling. It is particularly
important to do this at night while you sleep. Simply place a pillow or two under your ankle to keep it elevated. Once the tendon has healed, be sure to gradually return to more strenuous activities.
If flattened arches contributed to the injury, wear shoes with appropriate support or inserts to prevent the condition from progressing or recurring. If these non-surgical treatments have not been
able to provide relief of symptoms after several months, surgery may be performed to remove inflamed tissue. However, this is not usually recommended unless all other options have been exhausted.
Consult your doctor for more information about surgical treatment options.
Occasionally, conservative management of Achilles tendon conditions fails. This failure is more common in older male patients and those with longstanding symptoms, those who persist in full training
despite symptoms or those who have uncorrected predisposing factors. In these cases, surgery may be indicated. It should be remembered, however, that the rehabilitation program, particularly for
severe Achilles tendon injuries, is a slow, lengthy program. Surgery is only indicated when there is failure to progress in the rehabilitation program. Surgery should not be considered unless at
least six months of appropriate conservative management has failed to lead to improvement.
To lower your risk of Achilles tendonitis, stretch your calf muscles. Stretching at the beginning of each day will improve your agility and make you less prone to injury. You should also try to
stretch both before and after workouts. To stretch your Achilles, stand with a straight leg, and lean forward as you keep your heel on the ground. If this is painful, be sure to check with a doctor.
It is always a good idea to talk to your doctor before starting a new exercise routine. Whenever you begin a new fitness regimen, it is a good idea to set incremental goals. Gradually intensifying
your physical activity is less likely to cause injury. Limiting sudden movements that jolt the heels and calves also helps to reduce the risk of Achilles tendonitis. Try combining both high- and
low-impact exercises in your workouts to reduce stress on the tendon. For example, playing basketball can be combined with swimming. It doesn?t matter if you?re walking, running, or just hanging out.
To decrease pressure on your calves and Achilles tendon, it?s important to always wear the right shoes. That means choosing shoes with proper cushioning and arch support. If you?ve worn a pair of
shoes for a long time, consider replacing them or using arch supports. Some women feel pain in the Achilles tendon when switching from high heels to flats. Daily wearing of high heels can both
tighten and shorten the Achilles tendon. Wearing flats causes additional bending in the foot. This can be painful for the high-heel wearer who is not accustomed to the resulting flexion. One
effective strategy is to reduce the heel size of shoes gradually. This allows the tendon to slowly stretch and increase its range of motion.