tendonitis is one of the most common running injuries. The achilles tendon is the large tendon at the back of the ankle. It connects the calf muscles made up of the gastrocnemius and soleus to the
heel bone or calcaneus. It provides the power in the push off phase of walking and running where huge forces are transmitted through the achilles tendon. Achilles tendonitis is often now referred to
as achilles tendinopathy. This is because the term tendinopathy covers all types of overuse achilles tendon injury. Strictly speaking tendonitis suggests an inflammatory condition of the tendon but
in reality few achilles tendon injuries are actually down to pure inflammation. Soleus muscleThe main finding, particularly in older athletes is usually degeneration of the tissue with a loss of
normal fibre structure. Other very similar conditions may actually be due to inflammation or degeneration of the tendon sheath which surrounds the tendon rather than the achilles tendon itself. In
addition to being either chronic or acute, achilles tendonitis can also be at the attachment point to the heel called insertional achilles tendonitis or in the mid-portion of the tendon typically
around 4cm above the heel. Healing of the achilles tendon is often slow, due to its poor blood supply.
Tendinitis most often occurs when a tendon is over used. As the foot extends the Achilles tendon engages the calf muscles. The calf muscle generates force, which is transferred to the foot via this
tendon. As this action repeats the tendon will endure large amounts of stress. An under-trained or inexperienced athlete is most likely to be affected by tendinitis since their body is not accustomed
to the stress involved with athletics. Improper foot mechanics is another common cause of Achilles tendinitis. A properly functioning foot will distribute weight evenly across the foot. On the
contrary, if the foot is experiencing improper mechanics, the weight of the body will not be evenly distributed. This can result in tendinitis, plantar fasciitis, calluses, bunions, neuromas and much
People with Achilles tendinitis may experience pain during and after exercising. Running and jumping activities become painful and difficult. Symptoms include stiffness and pain in the back of the
ankle when pushing off the ball of the foot. For patients with chronic tendinitis (longer than six weeks), x-rays may reveal calcification (hardening of the tissue) in the tendon. Chronic tendinitis
can result in a breakdown of the tendon, or tendinosis, which weakens the tendon and may cause a rupture.
Laboratory studies usually are not necessary in evaluating and diagnosing an Achilles tendon rupture or injury, although evaluation may help to rule out some of the other possibilities in the
differential diagnosis. Imaging studies. Plain radiography: Radiographs are more useful for ruling out other injuries than for ruling in Achilles tendon ruptures. Ultrasonography: Ultrasonography of
the leg and thigh can help to evaluate the possibility of deep venous thrombosis and also can be used to rule out a Baker cyst; in experienced hands, ultrasonography can identify a ruptured Achilles
tendon or the signs of tendinosis. Magnetic resonance imaging (MRI): MRI can facilitate definitive diagnosis of a disrupted tendon and can be used to distinguish between paratenonitis, tendinosis,
The best treatment for Achilles tendonitis is preventative, stretching and warming up properly before starting an activity. Proper rest, accompanied by stretching and icing to reduce swelling, can
help to heal an overworked Achilles tendon. Placing an adequate heel lift in both shoes will allow the heel to have contact with the ground without placing stress on the Achilles tendon. Wear a tie
shoe that is stiff soled and has a wide base, then add an over-the-counter or custom foot orthosis inside the shoe to prevent the twisting motion of the Achilles tendon due to over pronation. In the
event that the tendon is unable to heal due to your life style or activity, you may have to be put in a walking cast for a short period to give it a chance to heal. You need to have the doctor,
physical therapist, or come in to our facility to check for a leg length difference due to the walking cast being higher. This is to prevent any discomfort to the hips. After the tendon has healed
and before the foot is taken out of the walking cast, range of motion at the ankle must be tested and if the foot is not allowed to properly bend upwards 15 degrees then the tightness in the calf
will cause the foot to over pronate and reinjure. A stretching program will be needed to loosen up the calf muscle before much weight bearing is done without the cast. The stretching program can be
found at the menu for feet hurt. If necessary a heel lift can be put in both shoes to help take the stress off the tendon. Should the tightness of the calves be the primary cause for the Achilles
tendon damage and stretching has not loosen the Achilles tendon sufficiently, then discussion with your doctor for a calf release may have to be considered.
Treating this surgically, there are numerous methods to repair the tendon. Most commonly, Achilles tendon is exposed through an incision at the back of the ankle. After identifying both ends of
ruptured tendon, the edges got trimmed and then both ends were sutured together with optimal tension. To get a better outcome with fixation, an anchor may have to be in place in calcaneus, provided
the rupture is very low. Care must be taken to avoid injuries to the nerves located adjacent to the tendon.
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.