Achilles tendinitis means the inflammation of the tissues that link a muscle to a bone. It connects the calf muscle to the heel bone and travels along the back of the lower leg. The Achilles tendon, commonly known as the heel cord, assists in lifting the heel off the ground, making walking easier.
Achilles Tendonitis and Achilles Tendonosis
Two common diseases that occur in the heel cord are Achilles tendonitis and Achilles tendonosis.
Achilles tendonitis is a disease in which the Achilles tendon becomes inflamed. This inflammation is usually transient. If not treated promptly, the problem can progress to tendon degeneration (Achilles tendonosis), in which the tendon loses its structured structure and is prone to microscopic tears. The area where the Achilles tendon joins to the heel bone is sometimes affected by degeneration. Chronic deterioration, with or without pain, can cause the tendon to rip in rare circumstances.
Achilles tendonitis and tendonosis are "overuse" illnesses that are frequently induced by a sudden increase in repetitive activity involving the Achilles tendon. Such activity immediately increases strain on the tendon, resulting in micro-injury of the tendon fibers. Due to this continued pressure on the tendon, the body is unable to repair the injured tissue. The structure of the tendon is then altered, resulting in ongoing pain.
Athletes are particularly vulnerable to Achilles tendon injury. Achilles tendinitis and tendonosis are widespread among those with employment that inflict stress on their ankles and feet, such as workers, as well as among "weekend warriors". These are persons who are less physically fit and only participate in sports on weekends or seldom.
Furthermore, persons who overpronate (flatten the ball of the foot) are more likely to develop Achilles tendinitis and tendonosis as a result of the strain on the tendon when walking. Excessive pronation might affect the Achilles tendon if these persons wear shoes with insufficient support.
Symptoms associated with Achilles tendonitis and tendonosis include
Pain, soreness, stiffness, tenderness inside the tendon. This can be anywhere along the tendon pathway from the attachment of the tendon directly at the top of the heel upwards from the area just below the calf muscle. The pain often occurs in the morning or after periods of rest, then improves slightly with movement, but then worsens with increased activity.
Tenderness or sometimes intense pain when the tendon is squeezed from the sides. However, there is less tenderness when pressing directly on the back of the tendon.
When the disorder progresses to degeneration, the tendon may enlarge and nodules may develop in the area where the tissue has been damaged.
To diagnose Achilles tendonitis or tendonosis, the surgeon examines the patient's foot and ankle and assesses the tendon's range of motion and condition. The extent of the disease can be examined in more detail with X-rays or other imaging methods.
Treatment approaches for Achilles tendonitis or tendonosis are determined by how long the injury has been ongoing and the degree of damage to the tendon. In the early stage, when there is sudden (acute) inflammation, one or more of the following options may be recommended
Immobilization (loss of mobility). Immobilization may include the use of a cast or a removable walking boot to reduce strain along the Achilles tendon and promote healing.
Ice. To reduce swelling from inflammation, apply an ice pack over a thin towel to the affected area every hour for 20 minutes. Do not put ice directly on the skin.
Oral medicines. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help reduce pain and inflammation in the early stage of discomfort.
Orthotics. For those with excessive pronation or gait abnormalities, special orthotic devices may be prescribed.
Night splints. Night splints help maintain flexibility in the Achilles tendon during sleep.
Physical therapy. Physical therapy may include strengthening exercises, soft tissue massage/mobilization, walking and jogging training, stretching and ultrasound therapy.
When is surgery necessary?
Surgical intervention may be necessary if non-surgical approaches fail to restore the tendon to its normal condition. The foot and ankle surgeon will choose the best procedure to repair the tendon depending on the extent of the injury, the patient's age and activity level, and other factors.
To prevent recurrence of Achilles tendonitis or tendonosis after surgical or non-surgical treatment, the foot and ankle surgeon may recommend strengthening and stretching the calf muscles with daily exercises. Wearing appropriate footwear for the type of foot and activity is also important in preventing recurrence of the condition.