Regarding Achilles Tendinitis

Overview


Achilles TendonAchilles tendinitis is when the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot. This tendon is called the Achilles tendon. It is used for walking, running, and jumping.






Causes


Like any muscle or tendon in the body, the older we get, the more likely we are to sustain an injury. So middle-aged men and women are most at risk, with a slightly higher risk factor attributed to males. Those who participate in more intense athletic activities like high impact sports (tennis, running, basketball) are most susceptible to the injury. Certain underlying medical conditions can also be a contributing factor. Diabetics are more at risk of suffering from Achilles Tendinitis, as are those who are not in great physical shape. Some antibiotics, particularly fluoroquinolones can make one more likely to suffer a strained Achilles Tendon.






Symptoms


Symptoms of acute achilles tendonitis will be a gradual onset of achilles pain at the back of the ankle, just above the heel bone. This may develop over a period of days. The achilles tendon may be painful and stiff at the start of exercise and first thing in the morning. As the tendon warms up the pain will go often for it to return later in the day or towards the end of a prolonged training session. The tendon will be very tender on palpation or pressing in on the achilles tendon or squeezing it from the sides. Chronic achilles tendonitis may follow on from acute achilles tendonitis if it goes untreated or is not allowed sufficient rest. Chronic achilles tendonitis is a difficult condition to treat, particularly in older athletes who appear to suffer more often.






Diagnosis


The doctor will perform a physical exam. The doctor will look for tenderness along the tendon and pain in the area of the tendon when you stand on your toes. X-rays can help diagnose bone problems. An MRI scan may be done if your doctor is thinking about surgery or is worried about the tear in the Achilles tendon.






Nonsurgical Treatment


Initial treatment of mild Achilles tendinitis involves rest, stretching exercises, and non-prescriptive medications to relieve pain and reduce inflammation. These medications include nonsteroidal anti-inflammatory drugs (NSAID) such as ibuprofen or naproxen. Relief of pain and swelling may be achieved with the application of ice for15 minutes at a time. Sleeping with the affected foot propped up on a pillow may also relieve swelling. Adequate time must be given to rest and recovery, meaning months or weeks, to prevent re-injury of the Achilles tendon. Most people make a full recovery and are able to return to their regular sports and exercise programs.


Achilles Tendonitis






Surgical Treatment


There are two types of Achilles repair surgery for tendonitis (inflammation of the Achilles Tendon), if nonsurgical treatments aren't effective. Gastrocnemius recession - The orthopaedic surgeon lengthens the calf muscles to reduce stress on your Achilles tendon. D?bridement and repair - During this procedure, the surgeon removes the damaged part of the Achilles tendon and repairs the remaining tendon with sutures or stitches. Debridement is done when the tendon has less than 50% damage.






Prevention


Wear shoes that fit correctly and support your feet: Replace your running or exercise shoes before the padding or shock absorption wears out. Shock absorption greatly decreases as the treads on the bottoms or sides of your shoes begin to wear down. You may need running shoes that give your foot more heel or arch support. You may need shoe inserts to keep your foot from rolling inward. Stretch before you exercise: Always warm up your muscles and stretch gently before you exercise. Do cool down exercises when you are finished. This will loosen your muscles and decrease stress on your Achilles tendon. Exercise the right way: If your tendinitis is caused by the way that you exercise, ask a trainer, coach, or your caregiver for help. They can teach you ways to train or exercise to help prevent Achilles tendinitis. Do not run or exercise on uneven or hard surfaces. Instead, run on softer surfaces such as treadmills, rubber tracks, grass, or evenly packed dirt tracks.

Achilles Tendinitis

Overview


Achilles Tendon Achilles tendinitis (tendonitis) or Achilles tendon inflammation occurs when the Achilles tendon becomes inflamed, as a result, of the Achilles tendon being put under too much strain. The Achilles tendon joins the calf muscles to the heel bone, and is found at the back of a person's lower leg. It is the largest tendon in the body and can endure great force, but is still susceptible to injury. Achilles tendinitis is usually the result of strenuous, high impact exercise, such as running. If ignored, Achilles tendinitis can lead to the tendon tearing or rupturing, and therefore it is important to seek the necessary treatment. Sometimes, treatment can be as simple as getting rest or changing an exercise routine. However, in more severe cases, surgery may be required.






Causes


Some of the causes of Achilles tendonitis / tendinosis include. Overuse injury - this occurs when the Achilles tendon is stressed until it develops small tears. Runners seem to be the most susceptible. People who play sports that involve jumping, such as basketball, are also at increased risk. Arthritis - Achilles tendonitis can be a part of generalised inflammatory arthritis, such as ankylosing spondylitis or psoriatic arthritis. In these conditions both tendons can be affected. Foot problems - some people with over pronated feet (Flat Feet) or feet that turn inward while walking are prone to Achilles tendonitis. The flattened arch pulls on calf muscles and keeps the Achilles tendon under tight strain. This constant mechanical stress on the heel and tendon can cause inflammation, pain and swelling of the tendon. Being overweight can make the problem worse. Footwear - wearing shoes with minimal support while walking or running can increase the risk, as can wearing high heels. Overweight and obesity - being overweight places more strain on many parts of the body, including the Achilles tendon.






Symptoms


Common symptoms of Achilles tendinitis include weakness in the leg, slight pain above the heel in the lower leg after activity, feeling of stiffness in the leg that usually appears in the morning and lessens throughout the day, bad pain the day after exercising, pain as you climb stairs or go uphill, swelling in the area of the Achilles tendon, creaking or cracking noise when you press on the Achilles tendon.






Diagnosis


The doctor will perform a physical exam. The doctor will look for tenderness along the tendon and pain in the area of the tendon when you stand on your toes. X-rays can help diagnose bone problems. An MRI scan may be done if your doctor is thinking about surgery or is worried about the tear in the Achilles tendon.






Nonsurgical Treatment


Self-care strategies include the following steps, often known by the acronym R.I.C.E, Rest. You may need to avoid exercise for several days or switch to an activity that doesn't strain the Achilles tendon, such as swimming. In severe cases, you may need to wear a walking boot and use crutches. Ice. To decrease pain or swelling, apply an ice pack to the tendon for about 15 minutes after exercising or when you experience pain. Compression. Wraps or compressive elastic bandages can help reduce swelling and reduce movement of the tendon. Elevation. Raise the affected foot above the level of your heart to reduce swelling. Sleep with your affected foot elevated at night.


Achilles Tendinitis






Surgical Treatment


It is important to understand that surgery may not give you 100% functionality of your leg, but you should be able to return to most if not all of your pre-injury activities. These surgical procedures are often performed with very successful results. What truly makes a difference is your commitment to a doctor recommended rehabilitation program after surgery as there is always a possibility of re-injuring your tendon even after a surgical procedure. One complication of surgical repair for Achilles tendon tear is that skin can become thin at site of incision, and may have limited blood flow.






Prevention


Suggestions to reduce your risk of Achilles tendonitis include, incorporate stretching into your warm-up and cool-down routines, maintain an adequate level of fitness for your sport, avoid dramatic increases in sports training, if you experience pain in your Achilles tendon, rest the area. Trying to ?work through? the pain will only make your injury worse, wear good quality supportive shoes appropriate to your sport. If there is foot deformity or flattening, obtain orthoses, avoid wearing high heels on a regular basis. Maintaining your foot in a ?tiptoe? position shortens your calf muscles and reduces the flexibility of your Achilles tendon. An inflexible Achilles tendon is more susceptible to injury, maintain a normal healthy weight.

All About Achilles Tendinitis

Overview


Achilles TendonitisAchilles 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.






Causes


Achilles tendonitis is aggravated by activities that repeatedly stress the tendon, causing inflammation. In some cases even prolonged periods of standing can cause symptoms. In many people who have developed achilles tendonitis, chronic shortening of the gastroc-soleus muscle complex is the reason that home remedies and anti-inflammatory medications fail. In these instances the muscle itself becomes shortened and creates a constant stress at the tendon?s attachment. Like a green branch that is slowly bent, eventually it begins to breakdown. Over a prolonged period the tendon becomes inflamed, and in the worst cases, appears swollen and thickened. In certain circumstances attempts to heal have failed and the body?s inability to heal the tissue results in degenerative changes known as achilles tendonosis. Anti-inflammatory medication, stretching and ice may only provide temporary relief, because they address the inflammation but not the root cause.






Symptoms


Symptoms of acute achilles tendonitis will be a gradual onset of achilles pain at the back of the ankle, just above the heel bone. This may develop over a period of days. The achilles tendon may be painful and stiff at the start of exercise and first thing in the morning. As the tendon warms up the pain will go often for it to return later in the day or towards the end of a prolonged training session. The tendon will be very tender on palpation or pressing in on the achilles tendon or squeezing it from the sides. Chronic achilles tendonitis may follow on from acute achilles tendonitis if it goes untreated or is not allowed sufficient rest. Chronic achilles tendonitis is a difficult condition to treat, particularly in older athletes who appear to suffer more often.






Diagnosis


If you think you might have Achilles tendonitis, check in with your doctor before it gets any worse. Your doc will ask about the activities you've been doing and will examine your leg, foot, ankle, and knee for range of motion. If your pain is more severe, the doctor may also make sure you haven't ruptured (torn) your Achilles tendon. To check this, the doc might have you lie face down and bend your knee while he or she presses on your calf muscles to see if your foot flexes. Any flexing of the foot means the tendon is at least partly intact. It's possible that the doctor might also order an X-ray or MRI scan of your foot and leg to check for fractures, partial tears of the tendon, or signs of a condition that might get worse. Foot and ankle pain also might be a sign of other overuse injuries that can cause foot and heel pain, like plantar fasciitis and Sever's disease. If you also have any problems like these, they also need to be treated.






Nonsurgical Treatment


Relieving the stress is the first course of action. Treatment involves ice therapy and activity modification to reduce inflamation. Active stretching and strengthening exercises will assist rehabilitation of the gastrocnemius-soleus complex. When placed in a heeled shoe, the patient will immediately notice a difference, compared to flat ground. It is recommended that the patient be fitted with proper shoes & orthotics to control pronation and maintain proper alignment, relieving the stress on the achilles tendon. Tightness in the tendon itself can be helped by an extra heel lift added to the orthotics. The patient can expect a slow recovery over a period of months.


Achilles Tendinitis






Surgical Treatment


Achilles tendon repair surgery is often used to repair a ruptured or torn Achilles tendon, the strong fibrous cord that connects the two large muscles in the back of your calf to your heel bone. These muscles (the gastrocnemius and the soleus) create the power needed to push off with your foot or rise up on your toes. Achilles tendon ruptures are quite common. Most happen during recreational activities that require sudden bursts of muscle power in the legs. Often a torn Achilles tendon can be diagnosed with a physical examination. If swelling is present, the orthopaedist may delay the Achilles tendon surgery until it subsides.






Prevention


Stretching of the gastrocnemius (keep knee straight) and soleus (keep knee bent) muscles. Hold each stretch for 30 seconds, relax slowly. Repeat stretches 2 - 3 times per day. Remember to stretch well before running strengthening of foot and calf muscles (eg, heel raises) correct shoes, specifically motion-control shoes and orthotics to correct overpronation. Gradual progression of training programme. Avoid excessive hill training. Incorporate rest into training programme.
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