Achilles Tendonitis or
achilles tendinopathy which is probably a more accurate term is an overuse injury causing pain, inflammation and or degeneration of the thick achilles tendon at the back of the ankle. The term
achilles tendinopathy is probably a better term to describe the range of conditions that can cause achilles tendon pain. Achilles tendonitis can be either acute or chronic. Acute achilles tendonitis
is usually more painful and of recent onset. Chronic achilles tendonitis will have come on gradually and over weeks, not necessarily preventing activity.
Sometimes Achilles Tendinitis is a result of sudden trauma, as you might encounter from playing sports, but you can also have Achilles tendon pain as a result of small, unnoticed, day-to-day
irritations that inflame the tendon over time by a cumulative effect. In those with no history of trauma, Achilles Tendonitis is sometimes associated simply with long periods of standing. There are
several factors that can cause the gradual development of Achilles Tendinitis. Improper shoe selection, particularly using high heels over many years, increases your odds of developing the condition.
This is because high-heeled shoes cause your calf muscles to contract, leaving the tendon with a lot less slack in it. Inadequate stretching before engaging in athletic or other physically-demanding
activities also predisposes you to develop the problem. This is especially true in "weekend athletes", individuals who tend to partake in excessive physical activities on an intermittent basis.
Biomechanical abnormalities like excessive pronation (too much flattening of the arch) also tends to cause this condition. And it is much more common individuals with equinus. It is more common in
the middle-aged, the out-of-shape, smokers, and in those who use steroids. Men get the condition more frequently than women. Those involved in jumping and high-impact sports are particularly
Symptoms include pain in the heel and along the tendon when walking or running. The area may feel painful and stiff in the morning. The tendon may be painful to touch or move. The area may be swollen
and warm. You may have trouble standing up on one toe.
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose an Achilles injury such as Achilles tendonitis. Occasionally, further investigations such as
an Ultrasound, X-ray or MRI scan may be required to assist with diagnosis and assess the severity of the condition.
If you have ongoing pain around your Achilles tendon, or the pain is severe, book an appointment with your family physician and ask for a referral to a Canadian Certified Pedorthist. Your Pedorthist
will conduct a full assessment of your feet and lower limbs and will evaluate how you run and walk. Based on this assessment, your Pedorthist may recommend a foot orthotic to ease the pressure on
your Achilles tendon. As Achilles tendinitis can also be caused by wearing old or inappropriate athletic shoes for your sport, your Pedorthist will also look at your shoes and advise you on whether
they have appropriate support and cushioning. New shoes that don?t fit properly or provide adequate support can be as damaging as worn out shoes.
Surgery should be considered to relieve Achilles tendinitis only if the pain does not improve after 6 months of nonsurgical treatment. The specific type of surgery depends on the location of the
tendinitis and the amount of damage to the tendon. Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles place increased stress on
the Achilles tendon, this procedure is useful for patients who still have difficulty flexing their feet, despite consistent stretching. In gastrocnemius recession, one of the two muscles that make up
the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope-an instrument that contains a
small camera. Your doctor will discuss the procedure that best meets your needs. Complication rates for gastrocnemius recession are low, but can include nerve damage. Gastrocnemius recession can be
performed with or without d?bridement, which is removal of damaged tissue. D?bridement and repair (tendon has less than 50% damage). The goal of this operation is to remove the damaged part of the
Achilles tendon. Once the unhealthy portion of the tendon has been removed, the remaining tendon is repaired with sutures, or stitches to complete the repair. In insertional tendinitis, the bone spur
is also removed. Repair of the tendon in these instances may require the use of metal or plastic anchors to help hold the Achilles tendon to the heel bone, where it attaches. After d?bridement and
repair, most patients are allowed to walk in a removable boot or cast within 2 weeks, although this period depends upon the amount of damage to the tendon. D?bridement with tendon transfer (tendon
has greater than 50% damage). In cases where more than 50% of the Achilles tendon is not healthy and requires removal, the remaining portion of the tendon is not strong enough to function alone. To
prevent the remaining tendon from rupturing with activity, an Achilles tendon transfer is performed. The tendon that helps the big toe point down is moved to the heel bone to add strength to the
damaged tendon. Although this sounds severe, the big toe will still be able to move, and most patients will not notice a change in the way they walk or run. Depending on the extent of damage to the
tendon, some patients may not be able to return to competitive sports or running. Recovery. Most patients have good results from surgery. The main factor in surgical recovery is the amount of damage
to the tendon. The greater the amount of tendon involved, the longer the recovery period, and the less likely a patient will be able to return to sports activity. Physical therapy is an important
part of recovery. Many patients require 12 months of rehabilitation before they are pain-free.
Warm up slowly by running at least one minute per mile slower than your usual pace for the first mile. Running backwards during your first mile is also a very effective way to warm up the Achilles,
because doing so produces a gentle eccentric load that acts to strengthen the tendon. Runners should also avoid making sudden changes in mileage, and they should be particularly careful when wearing
racing flats, as these shoes produce very rapid rates of pronation that increase the risk of Achilles tendon injury. If you have a tendency to be stiff, spend extra time stretching. If you?re overly
flexible, perform eccentric load exercises preventively. Lastly, it is always important to control biomechanical alignment issues, either with proper running shoes and if necessary, stock or custom