Achilles tendinitis can be a
very crippling issue for runners - simply because the pain is enough to discourage loading of the foot. It can also be a tricky condition to treat because the tendon is not as heavily vascularized
(i.e. more blood flow) as muscle, and therefore lacks healing potential. It is highly recommended that you see a physical therapist as soon as you experience acute symptoms, so chronic tendonosis
(which is longer termed and harder to treat) does not set in.
Some of the causes of Achilles tendonitis 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 flat feet or hyperpronated feet (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. Quinolone antibiotics - can in some instances be associated with inflammatory tenosynovitis
and, if present, will often be bilateral (both Achilles), coming on soon after exposure to the drug.
There will be a gradual onset of achilles tendon pain over a period of weeks, or even months. The pain will come on during exercise and is constant throughout the training session. Pain will be felt
in the achilles tendon when walking especially up hill or up stairs. This is because the achilles is having to stretch further than normal. There is likely to be stiffness in the Achilles tendon
especially in the morning or after a long period of rest. This is thought to be due to adhesions between the tendon sheath and the tendon itself. Nodules or lumps may be found in the achilles tendon,
particularly 2-4cm above the heel and the skin will appear red. Pain and tenderness will be felt when pressing in on the achilles tendon which is likely to appear thickened or swollen. A creaking
sensation may be felt when press the fingers into the sides of the tendon and moving the ankle.This is known as crepitus.
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.
See your doctor or sports physiotherapist for further advice. You may be prescribed anti-inflammatory medicine and a rehabilitation programme. Sometimes, the ankle may be put into a walking boot or
cast to immobilise the ankle in the short term. Gentle calf stretching is the first stage of rehabilitation. Don?t stretch to the point of pain. Strengthening the Achilles tendon is the second stage.
Your doctor or sports physiotherapist will be able to advise you on exercises for this. Special exercises called eccentric calf raises, that contract the calf muscle as it is lengthening (during the
lowering part of the movement), are the standard exercise used in the rehabilitation of Achilles tendon injuries. Sometimes a heel raise or orthotics may be useful. As symptoms resolve, resume normal
weight-bearing activities gradually. Avoid running until all tenderness has gone. Swimming or cycling in low gear are good replacement activities.
The type of surgery you will have depends on the type of injury you are faced with. The longer you have waited to have surgery will also be a factor that determines what type of surgery is needed.
With acute (recent) tearing the separation in your Achilles tendon is likely to be very minimal. If you have an acute tear you may qualify for less invasive surgery (such as a mini-open procedure).
Surgeons will always choose a shorter, less invasive procedure if it is possible to do so. Most surgeons know that a less complicated procedure will have less trauma to the tendon and a much quicker
rate of recovery after the surgery.
While it may not be possible to prevent Achilles tendinitis, you can take measures to reduce your risk. Increase your activity level gradually. If you're just beginning an exercise regimen, start
slowly and gradually increase the duration and intensity of the training. Take it easy. Avoid activities that place excessive stress on your tendons, such as hill running. If you participate in a
strenuous activity, warm up first by exercising at a slower pace. If you notice pain during a particular exercise, stop and rest. Choose your shoes carefully. The shoes you wear while exercising
should provide adequate cushioning for your heel and should have a firm arch support to help reduce the tension in the Achilles tendon. Replace your worn-out shoes. If your shoes are in good
condition but don't support your feet, try arch supports in both shoes. Stretch daily. Take the time to stretch your calf muscles and Achilles tendon in the morning, before exercise and after
exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendinitis. Strengthen your calf muscles. Strong calf muscles enable the calf and Achilles tendon to
better handle the stresses they encounter with activity and exercise. Cross-train. Alternate high-impact activities, such as running and jumping, with low-impact activities, such as cycling and