Achilles tendonitis is a condition of irritation and inflammation of the large tendon in the back of the ankle. Achilles tendonitis is a common injury that tends to occur in recreational athletes. Overuse of the Achilles tendon can cause inflammation that can lead to pain and swelling. Achilles tendonitis is differentiated from another common Achilles tendon condition called Achilles tendinosis. Patients with Achilles tendinosis have chronic Achilles swelling and pain as a result of degenerative, microscopic tears within the tendon.Causes
Tight or fatigued calf muscles, which transfer the burden of running to the Achilles. This can be due to poor stretching, rapidly increasing distance, or over-training excessive hill running or speed work, both of which stress the Achilles more than other types of running. Inflexible running shoes, which, in some cases, may force the Achilles to twist. Runners who overpronate (feet rotate too far inward on impact) are most susceptible to Achilles tendinitis.Symptoms
The main symptom of Achilles tendonitis is a feeling of pain and swelling in your heel as you walk or run. Other symptoms include tight calf muscles and limited range of motion when flexing the foot. This condition can also make the skin in your heel feel overly warm to the touch.Diagnosis
Studies such as x-rays and MRIs are not usually needed to make the diagnosis of tendonitis. While they are not needed for diagnosis of tendonitis, x-rays may be performed to ensure there is no other problem, such as a fracture, that could be causing the symptoms of pain and swelling. X-rays may show evidence of swelling around the tendon. MRIs are also good tests identify swelling, and will show evidence of tendonitis. However, these tests are not usually needed to confirm the diagnosis; MRIs are usually only performed if there is a suspicion of another problem that could be causing the symptoms. Once the diagnosis of tendonitis is confirmed, the next step is to proceed with appropriate treatment. Treatment depends on the specific type of tendonitis. Once the specific diagnosis is confirmed, the appropriate treatment of tendonitis can be initiated.Nonsurgical Treatment
Treatment for achilles tendonitis is based around initially reducing pain and inflammation, stretching the muscles out and a gradual return to activity. No one single approach may cure achilles tendonitis, particularly a chronic condition but a combination of treatment approaches and patience will work best. It is essential the correct treatment is started as soon as possible in the acute stage to avoid the injury becoming chronic. Acute achilles tendonitis requires rest. Continuing to train on a painful achilles tendon could lead to the injury becoming chronic and more difficult to treat. Applying ice or cold therapy as soon as possible to a painful achilles tendon will reduce pain and inflammation. After the first 24 to 48 hours alternating hot and cold or just heat may be more beneficial. Tendons work better when they are warm but if they are painful then rest and ice. Wear a heel pad to raise the heel and shorten the calf muscles which in turn reduces some of the strain on the achilles tendon. This should only be a temporary measure while the achilles tendon is healing. An achilles tendon taping technique can aid rest by supporting the tendon with elastic bandages. This is an excellent way of taking the load off the tendon if you have to walk around on your feet as well as protecting the tendon when returning to full fitness. Achilles tendon exercisesMake sure you have the right running shoes for your foot type and the sport. If you are a runner that over-pronates then a motion control or support running shoe may be needed. Visit a specialist running shop for advice. In the later stages apply heat, especially before exercise. The tendon will perform better when warm. Finish with cold after training to reduce any inflammation.Surgical Treatment
Open Achilles Tendon Surgery is the traditional Achilles tendon surgery and remains the 'gold standard' of surgery treatments. During this procedure one long incision (10 to 17 cm in length) is made slightly on an angle on the back on your lower leg/heel. An angled incision like this one allows for the patient's comfort during future recovery during physical therapy and when transitioning back into normal footwear. Open surgery is performed to provide the surgeon with better visibility of the Achilles tendon. This visibility allows the surgeon to remove scar tissue on the tendon, damaged/frayed tissue and any calcium deposits or bone spurs that have formed in the ankle joint. Once this is done, the surgeon will have a full unobstructed view of the tendon tear and can precisely re-align/suture the edges of the tear back together. An open incision this large also provides enough room for the surgeon to prepare a tendon transfer if it's required. When repairing the tendon, non-absorbale sutures may be placed above and below the tear to make sure that the repair is as strong as possible. A small screw/anchor is used to reattach the tendon back to the heel bone if the Achilles tendon has been ruptured completely. An open procedure with precise suturing improves overall strength of your Achilles tendon during the recovery process, making it less likely to re-rupture in the future.Prevention
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 dance foot health 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.