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Achilles Tendonitis Defined & Explained
The Achilles tendon is the largest and one of the most crucial tendons in the body. It connects your calf muscles to your heel bone and is used during walking, running, climbing stairs, jumping, and standing on your tip toes. Although the Achilles tendon is resilient enough in withstanding great stresses from running and jumping, it is also prone to tendonitis, an inflammatory condition causing irritation and degeneration of the tendon due to overuse.
Inflammation is the body’s natural response to injury or disease, and often causes swelling, pain, or irritation. Achilles tendonitis responds in a very limited manner since there is little blood supply to the Achilles tendon. Instead of the tendon itself, the more appropriate descriptions are paratenonitis (inflammation of the surrounding sheath), tendinosis (degeneration within the tendon substance) or a combination of both.
This inflammation is typically short-lived. Over time, if not resolved by leaving unattended, the condition may progress to a substantial degeneration of the tendon (Achilles tendonosis), in which the tendon loses its organized structure and is likely to develop microscopic tears which act as sites for tendon swelling.
The Causative Factors Of Achilles Tendonitis
Many a reasons might be associated with Achilles tendonitis, some of which are listed below:
- Recent Increase in the intensity of running or jumping workouts
- Repetitive Activities which overload the tendon structure
- Postural Problems such as flatfoot or high-arched foot
- Poorly Fitting footwear providing minimal support
- Training Issues such as running on uneven or excessively hard or slanted surfaces
- Aging Process giving rise to tendinosis
- Certain Routine Activities such as gardening, raking, carpentry, cleaning, house, shoveling, painting, scrubbing, tennis, golf, skiing, throwing and pitching
- Stresses From Other Conditions such as rheumatoid arthritis, gout, psoriatic arthritis, thyroid disorders, or unusual medication reactions
- Occasionally An Infection from a cat or dog bite
- Length Differences in your legs that stresses soft-tissue structures
- Arthritis In A Joint that exerts undue pressure on soft-tissue structures
- Having Tight Calf Muscles and suddenly starting an aggressive exercise program over-stressing the Achilles tendon
- Having Bone Spur (Extra Bone Growth) at the point of Achilles tendon attachment to the heel bone rubbing against the tendon and causing pain
The High Risk Factors Of Achilles Tendonitis
Several factors may elevate your risk of Achilles tendonitis condition, including:
- Achilles tendonitis appears to be sex-related, occurring most commonly in men.
- Achilles tendonitis becomes more common with progressing age.
- Physical problems such as a naturally flat arch foot, obesity and stiff calf muscles can put more strain on the Achilles tendon.
- Bad training choices such as running in worn-out shoes can increase your risk of Achilles tendonitis.
- Cold weather, more than the warm one, can predispose the tendon to injury and pain.
- Running on hilly, sloping terrains also can put your Achilles tendon at high risk of getting injured and damaged.
- Certain medical conditions such as psoriasis or hypertension place the patient at a higher risk of developing Achilles tendonitis.
- Certain medications, including a type of antibiotic called Fluoroquinolone has been associated with higher ratios of Achilles tendonitis.
The Signs & Symptoms Of Achilles Tendonitis
Achilles tendonitis presents with a number of indications that make its diagnosis pretty simple and easy.
- Thickening of the tendon
- Burning Pain & Stiffness along the Achilles tendon with the morning activity
- Pain That Worsens with activity or exercise along the tendon or back of the heel
- Persistent Swelling that can become worse throughout the day with activity
- Severe Pain the day after exercising or heavy workout
- Achilles Tendon often becoming warm, tender and enlarged due to development of nodules in the damaged area
- Friction Noted with gentle palpation of the tendon during ankle motion
- Severe Pain & Limited Walking Ability indicating a partial tendon tear
- Difficulty flexing the affected foot
- Bone Spurs on the heel bone
Types Of Achilles Tendonitis
There are two types of Achilles tendonitis confronted by your podiatric specialist, based upon which part of the tendon is faced with inflammation.
- Noninsertional Achilles Tendinitis refers to when fibers in the middle portion of the tendon have begun to break down with tiny tears (degeneration), swell, and thicken. This type of tendonitis more commonly affects younger, active adults.
- Insertional Achilles Tendonitis involves the lower portion of the heel, the site where the tendon attaches (inserts) to the heel bone. In both types damaged tendon fibers may also calcify (harden) owing to calcium deposits. Bone spurs often form and present with insertional Achilles tendonitis. Insertional tendonitis can occur at any time, even in patients who lead a not-so-active life. More often it strikes from years of overuse such as in long distance runners, and sprinters in their middle-age.
The Diagnostic Procedure of Achilles Tendonitis
The diagnostic approach employed by your podiatric specialist at their orthopedic clinic for managing Achilles tendonitis treatment would follow the following sequence:
- Taking Down Patient’s History
- Examining The Foot Area That Suggests A Tear Or Bone Spurs
- Looking For Tenderness & Pain Along The Tendon When Asked To Stand On Your Toes
- Evaluating & Comparing The Range Of Ankle Motion Against The Healthy Side
- Confirming The Extent Of Tendon Damage Via Imaging Techniques Like:
- Plain X-rays
- Ultrasonography
- MRI
The Treatment Regimen Of Achilles Tendonitis
Incidentally, the main treatments for Achilles tendonitis do not involve or require surgery. It is worthwhile to note that it may take at least 2 to 3 months for the painful condition to subside completely. With the failure of home-based treatment steps, surgical intervention is done as the last resort.
The Noninvasive Treatment Mode
The noninvasive method comprises of the following steps:
- Rest is mandatory for swift healing.
- Ice-pack for massaging the affected area has a proven efficacy in lessening pain and inflammation.
- Pain-killer Medication in the form of NSAIDs may be advised for pain relief.
- Specific Exercises to strengthen your calf muscles are usually suggested.
- Physiotherapy is often recommended by your podiatrist to fine-tune the weakened muscles.
- A System Of Exercises that help fortify your calf muscles to take pressure off your tendon has been carefully developed to be employed.
- Low-Impact Exercise Alternatives such as swimming may help regain muscle strength.
- Custom Orthotic Devices such as heel lifts in shoes, orthotic shoes, cast, splint, or a walking boot may be utilized upon specialist’s advice.
- Injections, comprising of platelet-rich plasma or corticosteroids, prove to be good pain reducers and anti-inflammatory.
- Extracorporeal Shockwave Therapy, comprising of high-energy shockwave impulses, help stimulate the healing process in the damaged tendon tissue.
- Nitroglycerin Medication applied to the overlying skin may prove to be beneficial.
The Invasive Treatment Mode
If the injured tendon does not recover through nonsurgical regimen, you are often offered surgery to explore the painful tendon area and remove any damaged or inflamed tissue, or painful bony spurs on the heel.
- For Tendonitis:
- Surgery consists of cutting out the surrounding thickened and scarred sheath.
- The tendon itself is also explored and any split tears within the tendon are repaired.
- Motion is started almost immediately to prevent repeat scarring of the tendon to the sheath and overlying soft tissue.
- Weightbearing should follow as soon as pain and swelling permit, usually less than 1 to 2 weeks.
- Return to competitive activity takes 3 to 6 months.
- For Tendonosis:
- Brisement is of no benefit since tendinosis involves changes in the substance of the tendon.
- Surgery consists of cutting out scar tissue and calcification deposits within the tendon.
- Abnormal tissue is excised until tissue with normal appearance appears from beneath.
- The tendon is then repaired with suture.
- In older patients or when excision of the tendon is above 50 percent, one of the other tendons at the back of the ankle is transferred to the heel bone to assist the Achilles tendon with strength as well as improve blood supply to this area.
- For Paratenonitis:
- For paratenonitis, the brisement technique is an option.
- Local anesthetic is injected into the space between the tendon and its surrounding sheath to break up scar tissue.
- This can be beneficial in earlier stages of the problem 30 to 50 percent of the time, but may need to be repeated twice or thrice.
The Preventive Measures For Achilles Tendonitis
While it may not be possible to prevent Achilles tendonitis altogether, you can adopt measures to reduce your risk and delay the onset of the condition:
- Increase your activity level (duration & intensity) gradually.
- Take it easy & avoid activities that place excessive stress on your tendons.
- If you participate in a strenuous activity, warm up first by exercising at a slower pace.
- Choose your shoes carefully while exercising which should provide adequate cushioning for your heel and have a firm arch support to help reduce the tension in the Achilles tendon.
- Replace your worn-out shoes with new, supportive ones.
- Stretch daily your calf muscles and Achilles tendon in the morning, before exercise and after exercise to maintain flexibility.
- Strengthen your calf muscles to better handle the stresses they encounter with activity and exercise.
- Cross-train with alternate high-impact activities, such as running & jumping, with low-impact activities, such as cycling & swimming.