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Achilles Tendinitis

The Achilles tendon is a tendon that runs down the back of the lower leg and connects the calf muscle to the heel bone. This tendon allows you to extend your foot and point your toes and also raises the heel off the ground to facilitate walking.

Achilles tendinitis refers to the overuse injury of the Achilles tendon. Achilles tendinosis on the other hand refers to tendon degeneration.

Causes

Achilles tendinitis is caused by the overuse of the tendon, sudden increase in a repetitive activity, or sudden stress exerted on the Achilles tendon. People with excessive pronation have a tendency to develop Achilles tendinitis.

As one ages, the structure of the Achilles tendon has the tendency to weaken, making the individual more susceptible to injuries. Cases of Achilles tendinitis is observed to be more prevalent among middle-aged individuals who play sports like basketball and tennis only on the weekends and runners who abruptly change the intensity or duration of their runs.

In some instances, there are other factors not related to exercise that have been known to contribute to the risk. Rheumatoid arthritis and infection for instance have been correlated with Achilles tendinitis.

Other likely causes include the following:

  • Straining of the calf muscles secondary to repeated exercise and other physical activities
  • Exercising without warming up
  • Engaging in sports that entail hasty stops and direction changes (i.e. football, tennis, basketball, etc.)
  • Wearing ill-fitting shoes
  • Wearing high heels for a long time

There are also certain factors that increase one’s risk of developing Achilles tendinitis. Some of these factors include:

  • Sex – The condition is more common among men than in women.
  • Medical conditions – Individuals with high blood pressure and psoriasis are more predisposed to developing Achilles tendinitis compared to those who do not have the two conditions.
  • Age – The condition becomes more prevalent as one ages.
  • Training choices – Those who run on hilly terrains and wear worn-out shoes are more susceptible to developing Achilles tendinitis.
  • Physical problems – Individuals with a flat arch are more likely to develop the condition as more strain is put on the tendon.

Symptoms

  • Swelling, tenderness, or sometimes intense pain when pressure is applied on both sides of the tendon.
  • Pain, stiffness, and tenderness within the tendon. Pain often occurs when you wake up in the morning or after a long period of rest.
  • Difficulty flexing your foot or pointing the toes.
  • Tightening of the calf muscles and notable limitations in the motion range.
  • In some cases, affected individuals can feel the skin on the heel becoming overly warm to the touch.

Diagnosis

To check if the patient has Achilles tendinitis, the doctor would need to evaluate the reflexes, range of motion, flexibility, and alignment of both the foot and the ankle.

In some instances, one or more of the following tests will be required in order to accurately evaluate the condition:

  • Magnetic resonance imaging or MRI – MRI produce images that are highly detailed employing radio waves and a strong magnet.
  • Ultrasound – Ultrasounds employ sound waves to visualize soft tissues. It is also used to produce a real-time image of the tendon in action. When blood flow around the tendon needs to be evaluated, a color-Doppler ultrasound would be recommended.
  • X-rays – Since X-rays are not capable of visualizing the soft tissues, the test is usually carried out in order to rule out other likely conditions that manifest the same symptoms.

Prevention

While there is no foolproof way to prevent Achilles tendinitis, measures can be undertaken to help reduce one’s risk.
  • Exercise. If you are starting an exercise regimen, make sure you start slow and increase the intensity and the duration gradually.
  • Training. If you are training or about to participate in a strenuous activity, don’t forget to do warm up exercises first. If you feel pain during a particular exercise, it would be ideal to stop and rest first. Also, reduce tendon stress by foregoing strenuous exercise activities like hill running.
  • Cross-train. Alternate high-impact activities like jumping and running with low-impact routines like swimming and cycling.
  • Stretch. To maintain flexibility, always make it a point to stretch the calf muscles before and after exercise.
  • Footwear. Opt for footwear that will provide adequate cushioning and firm arch support. If your shoes are still in good condition but does not support your feet well, consider using arch supports.

Treatment

Fortunately, Achilles tendinitis will often respond to noninvasive treatments.

However, if symptoms persist and the pain becomes severe, other treatment options will be recommended.

Medications

Over-the-counter pain medications like naproxen (Aleve) and ibuprofen (Motrin IB and Advil) are often given to alleviate the pain. However, if the aforementioned medications won’t suffice, stronger medications will be prescribed to ease the swelling and the pain.

Physical Therapy

Orthotic devices – A shoe wedge or insert that can slightly elevate the heel is sometimes prescribed to help relieve tendon strain. It can also provide the much needed cushion so force exerted on the tendon is reduced.

Exercises – Therapists will often recommend strengthening and stretching exercises to help promote healing of the Achilles tendon as well as its other supporting structures.

Surgery

If Achilles tendinitis does not respond to conservative treatments, surgery to repair the tendon might be recommended.

If you experience the early signs of Achilles tendinitis, it is recommended that you see a doctor immediately. In most cases, you will be referred to a physiatrist (a doctor specializing in physical and rehabilitative medicine).

However, if you already have a ruptured Achilles tendon, you may need to schedule an appointment with an orthopedic surgeon.

Make the most of your visit by preparing answers to the following questions your attending physician will most likely ask:

  • Where does it hurt exactly?
  • Does resting alleviate the pain?
  • What is your typical exercise routine?
  • Did the pain start suddenly or gradually?
  • Have you made drastic changes to your exercise regimen?
  • What have you done to relieve the pain?
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