Achilles tendonitis is a condition wherein the Achilles tendon, at or near its insertion to back of the heel, becomes inflamed and causes pain. The Achilles tendon is one of
the longest and strongest tendons in the body. It is avascular (not supplied with blood vessels) so it can be slow to heal. The Achilles tendon is formed in the lower third of the leg. Two muscles
join to form the Achilles tendon, the Gastrocnemius and the Soleus which are commonly referred to as the calf muscle. The Achilles tendon works as an anti-pronator which means it helps to prevent the
foot from rolling inward.
A lot of stress on the feet is the cause of Achilles tendinitis. It is a common athletic injury. Things that can cause tendinitis include, pushing your body too fast and too soon, sudden increase in
activity, sports that cause you to quickly start and stop, poor fitting shoes, bad footwear, severe injury to the Achilles tendon, running or exercising on uneven ground, running uphill, tight calf
muscles, bone spur (extra bone growth in heel that rubs the tendon and causes pain), flat arches, feet that roll in (overpronation), and weak calf muscles, not warming up before exercising.
Paratenonitis presents in younger people. Symptoms start gradually and spontaneously. Aching and burning pain is noted especially with morning activity. It may improve slightly with initial activity,
but becomes worse with further activity. It is aggravated by exercise. Over time less exercise is required to cause the pain. The Achilles tendon is often enlarged, warm and tender approximately 1 to
4 inches above its heel insertion. Sometimes friction is noted with gentle palpation of the tendon during ankle motion. Tendinosis presents similarly but typically in middle-aged people. If severe
pain and limited walking ability are present, it may indicate a partial tear of the tendon.
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.
Make sure that the tendon is not torn through and through. If it is severed, you must see a doctor immediately so that the tendon can be repaired. Severe injuries can sever a tendon, without a skin
laceration being present. Testing involves moving the toes and foot to see if the tendon moves. If the tendon does not appear to move, it may be severed (comparing the injured tendon and its movement
to the same tendon on the uninjured foot may help). Very sharp pain, a sudden pop, or an obvious gap in the structure of the tendon are all signs of a rupture, and should be seen by a doctor as soon
as possible. If there is extreme swelling of the leg, and pain (out of proportion to the amount of trauma received), you may have sustained a vascular injury. A doctor must see this type of injury
immediately. If you are not sure, see a doctor. If you have multiple injured areas see a doctor immediately, in order to prevent excessive swelling and pain. If the above exam is negative, then you
may proceed with self-treatment. (However, if you are not sure of the extent of your injury, you should consult your doctor immediately). The sooner you begin to treat your injury by following
"R.I.C.E.", the better you will feel. Rest is very important. Take off your shoe, get off your feet, and relax. Ice should be applied as soon as possible. Never apply ice directly on the injured
area, as the cold may make the pain worse. Ice should be applied close to the injured site, between the heart and the injury, so that as the blood flows under the ice, it will be cooled. This cool
blood flowing into the injured area will help to reduce the swelling and pain. Apply the ice, wrapped in a cloth or over an elastic bandage, to the foot for 15 minutes, every 1-2 hours, for up to 3
days after an injury. If the ice is uncomfortable, or causes increased pain, do not continue to use it, and see a doctor. If you have poor circulation do not use ice, as this may cause a serious
problem. c. Compression is used to limit swelling, and to give support to the injured area. Compression should be applied to the entire foot, starting first at the toes and working back to the ankle.
If it is applied just to the injured area, increased swelling will occur in front and behind the wrapping. Compression should be applied with a 3-inch elastic bandage, beginning around the base of
all the toes, and then going around the foot and ankle. Continue over the calf muscle when possible. Compression reduces motion in the injured area and foot, and this decreases the pain, and allows
for quicker healing. The bandage should not be so tight that it causes increased pain or throbbing in the toes or foot. It should be comfortable! Do not remove the elastic bandage for the first 12
hours, unless it becomes too tight, or the pain increases, or the toes become pale, blue, or cool. If any of these things happen, immediately remove all bandages, and leave them off for several
hours. The normal color and temperature of the toes should return immediately. If not, see a doctor immediately! Continue until the swelling and pain subsides; it could take from several days to
several weeks. d. Elevation of the leg will aid in reducing swelling and pain. Blood rushes to an injured area to bring increased blood cells, that aid in healing. Gravity will also force blood to
the injured area. Too many cells and too much fluid will apply pressure to the injured nerves and tissues, and cause increased pain and delayed healing. Keep your foot elevated so that it is at least
parallel to the ground, or higher if it is comfortable. Do this for at least 48 hours, or until the throbbing subsides, when you lower the leg.
If non-surgical treatment fails to cure the condition then surgery can be considered. This is more likely to be the case if the pain has been present for six months or more. The nature of the surgery
depends if you have insertional, or non-insertional disease. In non-insertional tendonosis the damaged tendon is thinned and cleaned. The damage is then repaired. If there is extensive damage one of
the tendons which moves your big toe (the flexor hallucis longus) may be used to reinforce the damaged Achilles tendon. In insertional tendonosis there is often rubbing of the tendon by a prominent
part of the heel bone. This bone is removed. In removing the bone the attachment of the tendon to the bone may be weakened. In these cases the attachment of the tendon to the bone may need to be
reinforced with sutures and bone anchors.
A 2014 study looked at the effect of using foot orthotics on the Achilles tendon. The researchers found that running with foot orthotics resulted in a significant decrease in Achilles tendon load
compared to running without orthotics. This study indicates that foot orthoses may act to reduce the incidence of chronic Achilles tendon pathologies in runners by reducing stress on the Achilles
tendon1. Orthotics seem to reduce load on the Achilles tendon by reducing excessive pronation,