Achilles Tendinitis is a painful
condition. Running and walking are made possible by the Achilles tendon, which attaches the calf muscle to the heel bone. Strenuous exercise, jumping, and climbing are all movements that can strain
the tendon and calf muscles, causing an inflammation known as tendinitis. The injury to the Achilles can be mild, requiring only rest and over-the-counter anti-inflammatory drugs, or severe,
necessitating surgical repair of the damaged tendon. Chronic Achilles tendinitis can lead to micro tears in the tissue (tendinosis), which weaken the tendon and put it at risk for severe damage such
as a tear or rupture.
Achilles tendinitis is caused by repetitive or intense strain on the Achilles tendon, the band of tissue that connects your calf muscles to your heel bone. This tendon is used when you walk, run,
jump or push up on your toes. The structure of the Achilles tendon weakens with age, which can make it more susceptible to injury - particularly in people who may participate in sports only on the
weekends or who have suddenly increased the intensity of their running programs.
Patients with an Achilles tendon rupture frequently present with complaints of a sudden snap in the lower calf associated with acute, severe pain. The patient reports feeling like he or she has been
shot, kicked, or cut in the back of the leg, which may result in an inability to ambulate further. A patient with Achilles tendon rupture will be unable to stand on his or her toes on the affected
side. Tendinosis is often pain free. Typically, the only sign of the condition may be a palpable intratendinous nodule that accompanies the tendon as the ankle is placed through its range of motion
(ROM). Patients with paratenonitis typically present with warmth, swelling, and diffuse tenderness localized 2-6 cm proximal to the tendon's insertion. Paratenonitis with tendinosis. This is
diagnosed in patients with activity-related pain, as well as swelling of the tendon sheath and tendon nodularity.
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.
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.
Percutaneous Achilles Tendon Surgery. During this procedure the surgeon will make 3 to 4 incisions (approx. 2.5 cm long) on both sides of the Achilles tendon. Small forceps are used to free the
tendon sheath (the soft tissue casing around your Achilles tendon) to make room for the surgeon to stitch/suture any tears. Skilled surgeons may perform a percutaneous achilles tendon surgery with
ultrasound imaging techniques to allow for blink suturing with stab incisions made by a surgical suture needle. This procedure can be done in 3 different ways depending on the preference and
experience of your surgeon. Instead of making several 2.5 cm incisions for this procedure, some surgeons will use guided imaging with an ultrasound to see the Achilles tendon tissue without having to
open up your ankle. For this technique, they will use a surgical needle to repeatedly stab your Achilles tendon. These "stab incisions" will allow the surgeon to "blindly" suture your tendon without
seeing the actual tissue. As another option - some surgeons will only make 1 to 3 incisions for smaller surgical implements to repair your tendon while relying on imaging ultrasound to see your
damaged tissue. During either procedure the use of ultrasound imaging or endoscopic techniques requires a very skilled surgeon.
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,