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Achilles Tendonitis


The Achilles tendon is the longest and one of the strongest tendons in the body.  It connects the two major calf muscles (gastrocnemius and soleus) to the back of the heel.  Tendons are thick, fibrous cords of connective tissue which connect muscles to bone.  They facilitate movement of a bone or structure, in this case the Achilles tendon whose action is to plantarflex the ankle joint and help flex the knee joint.  Under too much strain and stress, even the strongest tendon can become injured.  Overuse can cause the tendon to become inflamed (Achilles tendinitis).  As the injury progresses, collagen degeneration and scar formation can occur within the tendon.  Not only does this reduce the flexibility of the tendon, thickening or lumps can be felt within the region of scar formation.  If the unhealthy Achilles tendon continues to undergo overuse injury, it could rupture or tear.

Symptoms of Achilles Tendinitis

 

  • Ache or sharp pain anywhere along the back of the tendon and posterior heel
  • Limited ankle flexibility
  • Redness or heat over the painful area
  • Thickening of the tendon
  • Severe pain the day after exercising
  • Pain and stiffness along the tendon in the morning
  • Bone spur at the back of the heel
  • Swelling at the injury site

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Causes of Achilles Tendinitis

 

Achilles tendinitis is typically not related to a specific traumatic incident, and results from repetitive stress to the tendon.  This can be seen when individuals push their bodies too much too soon, but other factors can also contribute to the injury.  These factors are:

 

  • Overuse
  • Increasing the intensity of activity too quickly
  • Changing training surfaces too abruptly (soft to hard)
  • Inappropriate footwear
  • Too tight or fatigued muscles
  • Not stretching enough before activity
  • Deviated or unstable rearfoot axis
  • Leg length discrepancy

Other factors such as obesity, age, and diabetes can also predispose an individual to sustaining an Achilles tendon injury.  From a physiological perspective, the decreased vascularity around the Achilles tendon predisposes it to delayed healing compared to other tendons in the body.  The Achilles tendon can receive a stress load of 4 times our body weight during walking… imagine the stress load when running and jumping!  That is why Achilles injuries are most common in high-load, high-impact sports such as Basketball, Running, Track & Field.

Treatment for Achilles Tendinitis

 

  • RICE for a new injury – Rest the injury by cutting back on daily activities. Ice the injury using an ice pack for 15 mins, a few times a day.  Ice calms down the damaged tissue and slows down the blood flow to an injury, to reduce swelling, inflammation and controls the pain.  Compression could be using an elastic wrap or bandage.  Lastly, elevate the affected limb to reduce the swelling.
  • Eccentric stretching of the calf muscles daily, after the acute pain and inflammation has abated.
  • Strengthening of the leg muscles and ankle stabilizers.
  • Ultrasound and/or Shockwave Therapy can accelerate the body’s healing process, produce pain relief, promote reduction in muscle tension, and stimulate neovascularization.
  • Customised foot orthotics will improve foot alignment and control joint motions during propulsion/ toe-off in the gait cycle.
  • Immobilization is needed if the injury is severe.

Prevention of this injury includes wearing correct footwear for specific activities and lifestyle.  Individuals participating in sports or exercise should warm up properly, stretch and cool down, and alternate training regimes where possible.  Stretching is very important to injury prevention by maintaining optimal range of motion and increasing flexibility.  Changing exercise routines slightly can make a big difference in avoiding an overuse injury such as Achilles tendinitis.

 

If you are susceptible to or have a history of posterior heel pain, then contact one of our podiatry clinics today.  If this condition is recurrent and deteriorating, then you need to be mindful of preventing an eventual tendon tear or rupture.  Podiatrists are lower limb specialists who will assess, diagnose and devise a treatment plan which will accelerate your recovery, optimise your sports performance, and most importantly get rid of the pain in your Achilles.

 

 

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Author: Podiatrist Kerry SEAMAN

Editor: Principal Podiatrist Michael LAI