Achilles tendinitis occurs
when the band of tissue that connects the calf muscles at the back of the lower leg to the heel bone, the Achilles tendon, becomes inflamed. This condition is a result of overuse from intense
exercise, jumping, running, and other activities that strain the tendon and calf muscles.
There are two large muscles in the calf. These muscles are important for walking. They create the power needed to push off with the foot or go up on the toes. The large Achilles tendon connects these
muscles to the heel. Heel pain is most often due to overuse of the foot. Rarely it is caused by an injury. Tendinitis due to overuse is most common in younger people. It can occur in walkers,
runners, or other athletes. Achilles tendinitis may be more likely to occur if you Suddenly increase the amount or intensity of an activity. Your calf muscles are very tight (not stretched out). You
run on hard surfaces such as concrete. You run too often, you jump a lot (such as when playing basketball), you do not have shoes with proper support, your foot suddenly turns in or out. Tendinitis
from arthritis is more common in middle-aged and elderly people. A bone spur or growth may form in the back of the heel bone. This may irritate the Achilles tendon and cause pain and swelling.
Patients with an Achilles tendon rupture frequently present with complaints of a sudden snap in the lower calf associated with acute, severe pain. The patient reports feeling like he or she has been
shot, kicked, or cut in the back of the leg, which may result in an inability to ambulate further. A patient with Achilles tendon rupture will be unable to stand on his or her toes on the affected
side. Tendinosis is often pain free. Typically, the only sign of the condition may be a palpable intratendinous nodule that accompanies the tendon as the ankle is placed through its range of motion
(ROM). Patients with paratenonitis typically present with warmth, swelling, and diffuse tenderness localized 2-6 cm proximal to the tendon's insertion. Paratenonitis with tendinosis. This is
diagnosed in patients with activity-related pain, as well as swelling of the tendon sheath and tendon nodularity.
A doctor examines the patient, checking for pain and swelling along the posterior of the leg. The doctor interviews the patient regarding the onset, history, and description of pain and weakness. The
muscles, tissues, bones, and blood vessels may be evaluated with imaging studies, such as X-ray, ultrasound, or MRI.
With proper care for the area, the pain in the tendon should lessen over three weeks, but it should be noted that the healing of the area continues and doesn't even peak until at least six weeks
following the initial injury. This is due to scar tissue formation, which initially acts like the glue to bond the tissue back together. Scar tissue will continue to form past six weeks in some cases
and as long as a year in severe cases. After 6 months this condition is considered chronic and much more difficult to treat. The initial approach to treating Achilles tendonitis is to support and
protect the tendons by bracing any areas of the tendon that are being pulled on during use. It is important to loosen up the tendon, lessen the pain, and minimize any inflammation.
For paratenonitis, a technique called brisement is an option. Local anesthetic is injected into the space between the tendon and its surrounding sheath to break up scar tissue. This can be beneficial
in earlier stages of the problem 30 to 50 percent of the time, but may need to be repeated two to three times. Surgery consists of cutting out the surrounding thickened and scarred sheath. The tendon
itself is also explored and any split tears within the tendon are repaired. Motion is started almost immediately to prevent repeat scarring of the tendon to the sheath and overlying soft tissue, and
weight-bearing should follow as soon as pain and swelling permit, usually less than one to two weeks. Return to competitive activity takes three to six months. Since tendinosis involves changes in
the substance of the tendon, brisement is of no benefit. Surgery consists of cutting out scar tissue and calcification deposits within the tendon. Abnormal tissue is excised until tissue with normal
appearance appears. The tendon is then repaired with suture. In older patients or when more than 50 percent of the tendon is removed, one of the other tendons at the back of the ankle is transferred
to the heel bone to assist the Achilles tendon with strength as well as provide better blood supply to this area.
So what are some of the things you can do to help prevent Achilles Tendinitis? Warm Up properly: A good warm up is essential in getting the body ready for any activity. A well structured warm up will
prepare your heart, lungs, muscles, joints and your mind for strenuous activity. Balancing Exercises, Any activity that challenges your ability to balance, and keep your balance, will help what's
called proprioception, your body's ability to know where its limbs are at any given time. Plyometric Training, Plyometric drills include jumping, skipping, bounding, and hopping type activities.
These explosive types of exercises help to condition and prepare the muscles, tendons and ligaments in the lower leg and ankle joint. Footwear, Be aware of the importance of good footwear. A good
pair of shoes will help to keep your ankles stable, provide adequate cushioning, and support your foot and lower leg during the running or walking motion. Cool Down properly, Just as important as
warming up, a proper cool down will not only help speed recovery, but gives your body time to make the transition from exercise to rest. Rest, as most cases of Achilles tendinitis are caused by
overuse, rest is probably the single biggest factor in preventing Achilles injury. Avoid over training, get plenty of rest; and prevent Achilles tendinitis.