Achilles tendinitis is an overuse injury common in many sports that require lots of running and jumping. Once this condition becomes more chronic adhesions that form along the
tissues and the injury becomes more of a tendinosis. Treatment for a tendinosis is much different that for a tendinitis, so it is important to recognize what stage the injury is at in order to treat
it appropriately. An acute achilles tendinitis involves inflammation and would be treated with rest, ice, etc. Once the inflammation has decreased, research shows that eccentric exercises are
beneficial. Once there is tendinosis, it becomes imperative to break up those adhesions with ART and prescribe appropriate stretches and exercises.
Achilles tendinitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too soon, but
other factors can make it more likely to develop tendinitis, including a bone spur that has developed where the tendon attaches to the heel bone, Sudden increase in the amount or intensity of
exercise activity-for example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance, Tight calf muscles, Having tight calf muscles
and suddenly starting an aggressive exercise program can put extra stress on the Achilles tendon, Bone spur-Extra bone growth where the Achilles tendon attaches to the heel bone can rub against the
tendon and cause pain.
There will be a gradual onset of achilles tendon pain over a period of weeks, or even months. The pain will come on during exercise and is constant throughout the training session. Pain will be felt
in the achilles tendon when walking especially up hill or up stairs. This is because the achilles is having to stretch further than normal. There is likely to be stiffness in the Achilles tendon
especially in the morning or after a long period of rest. This is thought to be due to adhesions between the tendon sheath and the tendon itself. Nodules or lumps may be found in the achilles tendon,
particularly 2-4cm above the heel and the skin will appear red. Pain and tenderness will be felt when pressing in on the achilles tendon which is likely to appear thickened or swollen. A creaking
sensation may be felt when press the fingers into the sides of the tendon and moving the ankle.This is known as crepitus.
Confirming Achilles tendonitis may involve imaging tests. X-rays provide images of the bones of the foot and leg. Magnetic resonance imaging (MRI) is useful for detecting ruptures and degeneration of
tissue. Ultrasound shows tendon movement, related damage, and inflammation.
In order to treat achilles tendinitis effectively, it is important to complete a thorough examination of the entire lower extremity. Once the true cause is identified, a comprehensive treatment
program can be initiated to reduce inflammation and improve any faulty lower extremity biomechanics. Treatment options may include biomechanical analysis of gait. Splinting/bracing to alleviate the
strain on the tendon. Soft tissue mobilization/manual therapy to decrease inflammation and promote healing of the tendon. Strengthening/flexibility and proprioceptive exercises. Home exercise
program. Modalities for pain and inflammation (i.e. ultrasound, iontophoresis, electrical stimulation, ice). Methods to alter faulty mechanics (i.e taping, orthotics). Education about lifestyle
changes (i.e. proper shoes, activity modification).
Most people will improve with simple measures or physiotherapy. A small number continue to have major problems which interfere with their lifestyle. In this situation an operation may be considered.
If an operation is being considered, the surgeon will interview you and examine you again and may want you to have further treatment before making a decision about an operation. Before undergoing
Achilles tendonitis surgery, London based patients, and those who can travel, will be advised to undergo a scan, which will reveal whether there is a problem in the tendon which can be corrected by
surgery. Patients will also have the opportunity to ask any questions and raise any concerns that they may have, so that they can proceed with the treatment with peace of mind.
To prevent Achilles tendonitis or tendonosis from recurring after surgical or non-surgical treatment, the foot and ankle surgeon may recommend strengthening and stretching of the calf muscles through
daily exercises. Wearing proper shoes for the foot type and activity is also important in preventing recurrence of the condition.