Achilles Tendinitis is the inflammation of the Achilles Tendon located in the heel, and is typically caused by overuse of the affected limb. Most often, it occurs in athletes who
are not training with the proper techniques and/or equipment. When the Achilles Tendon is injured, blood vessels and nerve fibers from surrounding areas migrate into the tendon, and the nerve fibers
may be responsible for the discomfort. Healing is often slow in this area due to the comparably low amount of cellular activity and blood flowing through the area.
The cause of paratenonitis is not well understood although there is a correlation with a recent increase in the intensity of running or jumping workouts. It can be associated with repetitive
activities which overload the tendon structure, postural problems such as flatfoot or high-arched foot, or footwear and training issues such as running on uneven or excessively hard ground or running
on slanted surfaces. Tendinosis is also associated with the aging process.
Symptoms of Achilles Tendinitis include the following. Pain and stiffness along the Achilles tendon in the morning. Pain along the tendon or back of the heel that worsens with activity. Severe pain
the day after exercising. Thickening of the tendon. Bone spur (insertional tendinitis). Swelling that is present all the time and gets worse throughout the day with activity. If you have an Achilles
tendon rupture, you might feel a pop or snap, accompanied by a sharp pain behind your ankle. You are likely to have difficulty walking properly. If you have ruptured your Achilles tendon then surgery
is likely to be the best treatment option.
Your physiotherapist or sports doctor can usually confirm the diagnosis of Achilles tendonitis in the clinic. They will base their diagnosis on your history, symptom behaviour and clinical tests.
Achilles tendons will often have a painful and prominent lump within the tendon. Further investigations include US scan or MRI. X-rays are of little use in the diagnosis.
As with most soft tissue injuries the initial treatment is RICE - Rest, Ice, Compression and Elevation. In the early phase you?ll be unable to walk without a limp, so your Achilles tendon needs some
active rest from weight-bearing loads. You may need to be non or partial-weight-bearing, utilise crutches, a wedged achilles walking boot or heel wedges to temporarily relieve some of the pressure on
the Achilles tendon. Your physiotherapist will advise you on what they feel is best for you. Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes
each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. Anti-inflammatory medication (if tolerated) and natural substances eg arnica may help reduce your pain
and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain
reducing medication. As you improve a kinesio style supportive taping will help to both support the injured soft tissue.
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.
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.