Achilles Tendonitis is a term
that commonly refers to an inflammation of the Achilles tendon or its covering. It is an overuse injury that is common especially to joggers and jumpers, due to the repetitive action and so may occur
in other activities that requires the same repetitive action. Most experts now use the term Achilles tendinopathy to include both inflammation and micro-tears. But many doctors may still use the term
tendonitis out of habit.
There are a number of ways a person can develop Achilles tendinitis. Some causes are easier to avoid than others, but being aware of them can aid earlier diagnosis and help prevent serious injury.
Causes of Achilles tendinitis include, using incorrect or worn out shoes when running or exercising. Not warming up properly before exercise. Increasing intensity of exercise too quickly (e.g.
running speed or distance covered). Prematurely introducing hill running or stair climbing to exercise routine. Running on hard or uneven surfaces. Calf muscle is injured or has little flexibility
(this puts a lot of strain on the Achilles tendon). Sudden intense physical activity such as sprinting for the finish line. Achilles tendinitis can also be caused by differences in foot, leg or ankle
anatomy. For example, some people can have flatness in their foot where there would normally be an arch; this puts more strain on the tendon. The FDA has asked that a boxed warning be added to the
prescribing information for fluoroquinolone antibiotics. Patients taking these drugs may experience an increased risk of tendinitis and tendon rupture. Fluoroquinolones include Cipro (ciprofloxacin),
Factive (gemifloxacin), Levaquin (levofloxacin), Avelox (moxifloxacin), Noroxin (norfloxacin), Floxin (ofloxacin) and Proquin (ciprofloxacin hydrochloride). It is important to remember that the risk
for injury is not necessarily gone when the drug is stopped. Cases have been reported in which tendon problems occurred up to several months after the drug was discontinued.
Symptoms can vary from an achy pain and stiffness to the insertion of the Achilles tendon to the heel bone (calcaneus), to a burning that surrounds the whole joint around the inflamed thick tendon.
With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiffer the following day. This is especially true if your sheets are pushing down
on your toes and thereby driving your foot into what is termed plantar flexion (downward flexed foot), as this will shorten the tendon all night.
The diagnosis is made via discussion with your doctor and physical examination. Typically, imaging studies are not needed to make the diagnosis. However, in some cases, an ultrasound is useful in
looking for evidence of degenerative changes in the tendon and to rule out tendon rupture. An MRI can be used for similar purposes, as well. Your physician will determine whether or not further
studies are necessary.
As with most soft tissue injuries the initial treatment is RICE - Rest, Ice, Compression and Elevation. In the early phase you?ll be unable to walk without a limp, so your Achilles tendon needs some
active rest from weight-bearing loads. You may need to be non or partial-weight-bearing, utilise crutches, a wedged achilles walking boot or heel wedges to temporarily relieve some of the pressure on
the Achilles tendon. Your physiotherapist will advise you on what they feel is best for you. Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes
each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. Anti-inflammatory medication (if tolerated) and natural substances eg arnica may help reduce your pain
and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain
reducing medication. As you improve a kinesio style supportive taping will help to both support the injured soft tissue.
There are three common procedures that doctor preform in order help heal the tendinitis depending on the location of the tendinitis and amount of damage to the tendon, including: Gastrocnemius
recession - With this surgery doctors lengthen the calf muscles because the tight muscles increases stress on the Achilles tendon. The procedure is typically done on people who have difficulty
flexing their feet even with constant stretching. Debridement and Repair - When there is less than 50% damage in the tendon, it is possible for doctors to remove the injured parts and repair the
healthy portions. This surgery is most done for patients who are suffering from bone spurs or arthritis. To repair the tendon doctors may use metal or plastic anchors to help hold the Achilles tendon
in place. Patients have to wear a boot or cast for 2 weeks or more, depending and the damage done to the tendon. Debridement with Tendon Transfer - When there is more the 50% damage done to the
Achilles tendon, and Achilles tendon transfer is preformed because the remain healthy tissue is not strong enough. The tendon that helps the big toe move is attached to give added strength to the
damaged Achilles. After surgery, most patients don?t notice any difference when they walk or run.
As with all injuries, prevention is your best defense especially with injuries that are as painful and inconvenient as Achilles tendonitis. Options for how to prevent Achilles tendonitis include,
stretching- Stretching properly, starting slowly, and increasing gradually will be critical if you want to avoid Achilles tendonitis. To help maintain flexibility in the ankle joint, begin each day
with a series of stretches and be certain to stretch prior to, and after, any exercise or excessive physical activity. Orthotics and Heel Support- Bio-mechanically engineered inserts and heel cups
can be placed in your shoes to correct misalignments or bolster the support of your foot and are available without a prescription. The temporary heel padding that these provide reduces the length
that the Achilles tendon stretches each time you step, making it more comfortable to go about your daily routine. Proper Footwear- Low-heeled shoes with good arch support and shock absorption are
best for the health of your foot. Look into heel wedges and other shoe inserts to make sure that your everyday foot mechanics are operating under ideal conditions.