Topics discussed on this web page:
Achilles Tendinitis, Achilles Tendinosis,
Achilles Tendon Ruptures
What is the Achilles Tendon?
The Achilles Tendon is the large tendon running from the calf muscles (the gastrocnemius and soleus muscles) located in the back of the leg to the back of the heel.
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This muscle and tendon combination is responsible for allowing your foot to push off the ground when you're walking, running, and jumping. Because it's used so much in gait, the tendon can become inflamed. At this point we would name the problem "Achilles Tendinitis", because adding the suffix -itis to the end of a word means that tissue is inflamed.
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What activities causes Achilles Tendon Pain?
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.
Biomechanical abnormalities like excessive pronation (too much flattening of the arch) also tends to cause this condition.
It is more common in the middle-aged, the out-of-shape, smokers, and in those who use steroids.
What does Achilles Tendinitis feel like?
Symptoms vary because you can injure various areas of the muscle-tendon complex. The pain may be sharp, stabbing, piercing, shooting, burning or aching.
It is often most noticeable immediately after getting out of bed in the morning, or after periods of inactivity, like sitting down for lunch. After a couple minutes of walking around, it will often then settle down somewhat, before becoming symptomatic again after excessive time standing or walking.
But regardless of how the pain is perceived, Achilles tendon pain should not be left untreated due to the danger that the tendon can become weak, frayed, thickened, and eventually it may rupture.
How can you diagnose Achilles Tendinitis?
A podiatrist can usually make the diagnosis by clinical history and physical examination alone.
X-rays don't usually show much regarding damage to the tendon itself, though as X-rays can image bone well, they can show signs of calcification within the tendon (calcific tendinitis) or abnormal changes of the heel bone (posterior heel spur). In cases where we are uncertain as to the extent of the damage to the tendon itself, an ultrasound or an MRI scan may be necessary.
How can you treat
Achilles Tendinitis?
Complete rest is vital, and ice is of great help the first 2 days of the
injury. (Apply ice 15 minutes every hour). Taping, padding,
heel lifts, anti-inflammatory medications, immobilization, physiotherapy and
massage are all helpful in the acute stage.
Steroid injections weaken tendon and should generally not be used.
For chronic, difficult-to-treat cases, orthoses, custom-made appliances for the shoes, may be necessary to address any biomechanical abnormality. Good shoes and, in athletes, a strict pre-activity stretching regimen are also helpful in the long term.
For chronic problems involving the tendon where it attaches to the heel bone, an excellent new tool called Extracorporeal Shockwave Therapy (ESWT) has been developed. This is a new technology analogous to lithotripsy, the non-surgical technique that uses sound waves to break up kidney stones. In this case, however, it is used to break up early calcification within the tendon and to promote healing where the tendon attaches to bone.
Along with our partners Shockwave Therapy - BC, we are pleased to offer what we feel is the best ESWT technology available anywhere, the new-generation, piezoelectric version, which does not need anesthesia. For more information on ESWT, visit the website of our partners, Shockwave Therapy - BC.
Surgery is another alternative that may be appropriate. This may involve either the tendon itself, or the bone where the tendon attaches.
What if the Achilles Tendon isn't just inflamed, but ruptures?
If the injury is fresh, within hours of the injury, we would most likely suggest surgical repair of the tendon.
Older injuries may also be treated surgically, though some patients will improve by casting the leg. Diminished strength and re-rupture is more frequently seen in patients who are casted without surgery, so the inclination is to surgically repair ruptures in most cases involving younger, healthier patients.
Following surgical repair of Achilles Tendon injuries, the patient is usually casted, then when the cast is removed, the patient is followed up with stretching, strengthening exercises and physiotherapy.
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