If you have pain along the back of your leg
near your heel, you may have Achilles tendonitis. Achilles tendonitis is an overuse injury that commonly occurs in runners and ?weekend warriors?. The Achilles tendon is the largest tendon in the
body. Named after a tragic hero from Greek mythology, it connects your calf muscle to your heel bone to allow you to jump, run and walk. Achilles tendonitis is most common in middle-aged men, but it
can happen to anyone who has a sudden increase in physical activity. The risk is increased if you also have tight calf muscles and/or a flat arch in your foot. Other risk factors include running in
worn out shoes, cold weather, frequently running uphill or if you suffer from medical conditions such as diabetes or high blood pressure. There are two main types of Achilles tendinitis: insertional
and noninsertional. Insertional Achilles tendinitis involves the lower portion of the heel, where the tendon attaches to the heel bone. Noninsertional Achilles tendinitis is when the fibers in the
middle portion of the tendon have started to break down with tiny tears, swell, and/or thicken. This type is more often seen in younger, active people. Both types can also cause bone spurs. Achilles
tendonitis should be diagnosed by your doctor. However, if you experienced a sudden ?pop? in the back of your calf or heel, this might be something more serious like a ruptured or torn Achilles
tendon. If this happens, see your doctor immediately.
Achilles tendonitis occurs in sports such as running, jumping, dancing and tennis. Other risk factors include participation in a new sporting activity or increasing the intensity of participation.
Poor running technique, excessive pronation of the foot and poorly fitting footwear may contribute. In cyclists, the problem may be a low saddle, which causes extra dorsiflexion of the ankle when
pedalling. Quinolone antibiotics (eg, ciprofloxacin, ofloxacin) can cause inflammation of tendons and predispose them to rupture.
The onset of the symptoms of Achilles tendonitis tend to be gradual, with symptoms usually developing over a period of several days, or even weeks. Symptoms may include, Pain, this may be mild at
first and may only be noticeable after exercise. Over time the pain may become constant and severe. Stiffness, this is usually relieved by activity. Sluggishness in the leg. Tenderness, particularly
in the morning and most commonly felt just above where the tendon attaches to the heel bone. Swelling.
Physicians usually pinch your Achilles tendon with their fingers to test for swelling and pain. If the tendon itself is inflamed, your physician may be able to feel warmth and swelling around the
tissue, or, in chronic cases, lumps of scar tissue. You will probably be asked to walk around the exam room so your physician can examine your stride. To check for complete rupture of the tendon,
your physician may perform the Thompson test. Your physician squeezes your calf; if your Achilles is not torn, the foot will point downward. If your Achilles is torn, the foot will remain in the same
position. Should your physician require a closer look, these imaging tests may be performed. X-rays taken from different angles may be used to rule out other problems, such as ankle fractures. MRI
(magnetic resonance imaging) uses magnetic waves to create pictures of your ankle that let physicians more clearly look at the tendons surrounding your ankle joint.
Massage therapy improves blood flow to the muscles and tissues of the affected area while increasing range of motion and can prevent recurring injury. The healing process can be quickened using
ultrasound heat therapy to improve blood flow to the affected area. Wearing a night brace keeps the leg flexed, preventing stiffening of the tendon, which would impair healing. Stretching exercises
increase flexibility and allow the tendon to heal without shortening, a deformity resulting in chronic pain. Persistent Achilles pain may warrant the use of a cast or walking boot to be worn for 4-6
weeks stabilizing the tendon so it can heal. After removal of the cast or boot, physical therapy will be ordered to increase functionality of the affected limb. To reduce chronic inflammation of the
tendon, corticosteroid injections may be prescribed. It?s important to note that this corticosteroid treatment increases the risk of tendon rupture. Ultrasound imaging may be used by the physician
administering the steroid injection, in order to help visualize the affected area. When all other therapies have failed to or tendon rupture occurs, surgical intervention and repair of the muscles
and tendons is the last treatment option.
Surgery can be done to remove hardened fibrous tissue and repair any small tendon tears as a result of repetitive use injuries. This approach can also be used to help prevent an Achilles tendon
rupture. If your Achilles tendon has already ruptured or torn, Achilles tendon surgery can be used to reattach the ends of the torn tendon. This approach is more thorough and definitive compared to
non surgical treatment options discussed above. Surgical reattachment of the tendon also minimizes the change of re-rupturing the Achilles tendon.
Stretching of the gastrocnemius (keep knee straight) and soleus (keep knee bent) muscles. Hold each stretch for 30 seconds, relax slowly. Repeat stretches 2 - 3 times per day. Remember to stretch
well before running strengthening of foot and calf muscles (eg, heel raises) correct shoes, specifically motion-control shoes and orthotics to correct overpronation. Gradual progression of training
programme. Avoid excessive hill training. Incorporate rest into training programme.