Achilles tendonitis is commonly
seen in athletes who sustain an increase in training load, and is most often due to overuse. Tendons respond poorly to overuse, therefore healing is slow. This can leave a tendon pathologically
defective, which decreases tendon strength and leaves it less able to tolerate load, thus vulnerable to further injury or tendinosis. Extrinsic factors contributing to this condition include training
errors and inappropriate footwear. Intrinsic factors include inflexibility, weakness and malalignment. In other situations, there will be clinical inflammation, but objective pathologic evidence for
cellular inflammation is lacking, and in these conditions the term tendinosis is more appropriate. Tendinosis is a degeneration of the tendon?s collagen in response to chronic overuse; when overuse
is continued without giving the tendon time to heal and rest, such as with repetitive strain injury, tendinosis results. Even tiny movements, such as clicking a mouse, can cause tendinosis, when done
Achilles tendinitis may be caused by intensive hill running, sprinting, or stair climbing. Overuse resulting from the natural lack of flexibility in the calf muscles. Rapidly increasing intensity of
exercise, especially after a period of inactivity. Sudden and hard contraction of the calf muscles when exerting extra effort, like that in a final sprint or high jump.
The symptoms associated with Achilles tendonitis and tendonosis include, Pain-aching, stiffness, soreness, or tenderness-within the tendon. This may occur anywhere along the tendon?s path, beginning
with the tendon?s attachment directly above the heel upward to the region just below the calf muscle. Often pain appears upon arising in the morning or after periods of rest, then improves somewhat
with motion but later worsens with increased activity. Tenderness, or sometimes intense pain, when the sides of the tendon are squeezed. There is less tenderness, however, when pressing directly on
the back of the tendon. When the disorder progresses to degeneration, the tendon may become enlarged and may develop nodules in the area where the tissue is damaged.
The diagnosis is made via discussion with your doctor and physical examination. Typically, imaging studies are not needed to make the diagnosis. However, in some cases, an ultrasound is useful in
looking for evidence of degenerative changes in the tendon and to rule out tendon rupture. An MRI can be used for similar purposes, as well. Your physician will determine whether or not further
studies are necessary.
Proper footwear with a strong and secure counter (the heel circumference) may help to encourage heeling of the tendon. A tendinitis will occasionally resolve on it?s own, with rest, ice, and gentle
stretching. If symptoms persist for more than 2 weeks, consult your physician. Your physician may suggest physiotherapy and custom orthotics. Physiotherapy can suggest appropriate exercises and
modalities to aid in the healing process. Custom orthotics can be very successful in treating the problem, as the original cause may be due to an improper alignment of the foot and heel. Re-aligning
the foot to a neutral position may provide an optimal, biomechanically sound environment for healing to occur.
Chronic Achilles tendon tears can be more complicated to repair. A tendon that has torn and retracted (pulled back) into the leg will scar in the shortened position over time. Restoring normal tendon
length is usually not an issue when surgery is performed within a few weeks of the injury. However, when there has been a delay of months or longer, the treatment can be more complicated. Several
procedures can be used to add length to a chronic Achilles tear. A turndown procedure uses tissue folded down from the top of the calf to add length to the Achilles tendon. Tendon transfers from
other tendons of the ankle can also be performed to help restore function of the Achilles. The results of surgery in a chronic situation are seldom as good as an acute repair. However, in some
patients, these procedures can help restore function of a chronically damaged Achilles.
Achilles tendinitis cannot always be prevented but the following tips will help you reduce your risk. If you are new to a sport, gradually ramp up your activity level to your desired intensity and
duration. If you experience pain while exercising, stop. Avoid strenuous activity that puts excessive stress on your Achilles tendon. If you have a demanding workout planned, warm up slowly and
thoroughly. Always exercise in shoes that are in good condition and appropriate for your activity or sport. Be sure to stretch your calf muscles and Achilles tendon before and after working out. If
you suffer from Achilles tendinitis make sure you treat it properly and promptly. If self-care techniques don?t work, don?t delay. Book a consultation with a foot care expert or you may find yourself
sidelined from your favourite sports and activities.