Achilles tendinitis is often a misnomer, as most
problems associated with the Achilles tendon are not strictly an inflammatory response. A more appropriate term, which most experts now use, is Achilles tendinopathy which includes, Tendinosis,
microtears in the tissues in and around the tendon. Tendinitis, inflammation of the tendon Most cases of Achilles tendon pain is the result of tendinosis. Tendon inflammation (tendinitis) is rarely
the cause of tendon pain. Achilles tendinopathy is a common condition that occurs particularly in athletes and can be difficult to treat due to the limited vascular supply of the tendon and the
stress within the Achilles tendon with every step. Evidence indicates that treatment incorporating custom foot orthoses can improve this condition by making the foot a more effective lever in gait. A
2008 study reported between 50 and 100% relief (average 92%) from Achilles tendinopathy symptoms with the use of custom foot orthoses.
Poorly conditioned athletes are at the highest risk for developing Achilles tendonitis, also sometimes called Achilles tendinitis. Participating in activities that involve sudden stops and starts and
repetitive jumping (e.g., basketball, tennis, dancing) increases the risk for the condition. It often develops following sudden changes in activity level, training on poor surfaces, or wearing
inappropriate footwear. Achilles tendonitis may be caused by a single incident of overstressing the tendon, or it may result from a series of stresses that produce small tears over time (overuse).
Patients who develop arthritis in the heel have an increased risk for developing Achilles tendonitis. This occurs more often in people who middle aged and older. The condition also may develop in
people who exercise infrequently and in those who are just beginning an exercise program, because inactive muscles and tendons have little flexibility because of inactivity. It is important for
people who are just starting to exercise to stretch properly, start slowly, and increase gradually. In some cases, a congenital (i.e., present at birth) condition causes Achilles tendonitis.
Typically, this is due to abnormal rotation of the foot and leg (pronation), which causes the arch of the foot to flatten and the leg to twist more than normal.
The Achilles tendon is a strong muscle and is not usually damaged by one specific injury. Tendinitis develops from repetitive stress, sudden increase or intensity of exercise activity, tight calf
muscles, or a bone spur that rubs against the tendon. Common signs and symptoms of Achilles Tendinitis include, gradual onset of pain at the back of the ankle which may develop in several days up to
several months to become bothersome. Heel pain during physical activities which may diminish after warming up in early stages, or become a constant problem if the problem becomes chronic. Stiffness
at the back of the ankle in the morning. During inactivity, pain eases. Swelling or thickening of the Achilles tendon. Painful sensation if the Achilles tendon is palpated. If a pop is heard
suddenly, then there is an increased chance that the Achilles tendon has been torn and immediate medical attention is needed.
During an examination of the foot and ankle, you doctor will look for the following signs, Achilles tendon swelling or thickening. Bone spurs appearing at the lower part of the tendon at the back of
the hell. Pain at the middle or lower area of the Achilles tendon. Limited range of motion of the foot and ankle, and a decreased ability to flex the foot. Your doctor may perform imaging tests, such
as X-rays and MRI scans, to make a diagnosis of Achilles tendinitis. X-rays show images of the bones and can help the physician to determine if the Achilles tendon has become hardened, which
indicated insertional Achilles tendinitis. MRI scans may not be necessary, but they are important guides if you are recommended to have surgical treatment. An MRI can show the severity of the damage
and determine what kind of procedure would be best to address the condition.
Initial treatment consists of medication and ice to relieve the pain, stretching and strengthening exercises, and modification of the activity that initially caused the problem. These all can be
carried out at home, although referral to a physical therapist or athletic trainer for further evaluation and treatment may be helpful. Occasionally a walking boot or cast may be recommended to
immobilize the tendon, allowing the inflammation to settle down. For less severe cases or after immobilization, a heel lift may be prescribed to reduce stress to the tendon. This may be followed by
an elastic bandage wrap of the ankle and Achilles tendon. Orthotics (arch supports) may be prescribed or recommended by your physician. Surgery to remove the inflamed tendon lining or degenerated
tendon tissue is rarely necessary and has shown less than predictable results.
If several months of more-conservative treatments don't work or if the tendon has torn, your doctor may suggest surgery to repair your Achilles tendon.
To lower your risk of Achilles tendonitis, stretch your calf muscles. Stretching at the beginning of each day will improve your agility and make you less prone to injury. You should also try to
stretch both before and after workouts. To stretch your Achilles, stand with a straight leg, and lean forward as you keep your heel on the ground. If this is painful, be sure to check with a doctor.
It is always a good idea to talk to your doctor before starting a new exercise routine. Whenever you begin a new fitness regimen, it is a good idea to set incremental goals. Gradually intensifying
your physical activity is less likely to cause injury. Limiting sudden movements that jolt the heels and calves also helps to reduce the risk of Achilles tendonitis. Try combining both high- and
low-impact exercises in your workouts to reduce stress on the tendon. For example, playing basketball can be combined with swimming. It doesn?t matter if you?re walking, running, or just hanging out.
To decrease pressure on your calves and Achilles tendon, it?s important to always wear the right shoes. That means choosing shoes with proper cushioning and arch support. If you?ve worn a pair of
shoes for a long time, consider replacing them or using arch supports. Some women feel pain in the Achilles tendon when switching from high heels to flats. Daily wearing of high heels can both
tighten and shorten the Achilles tendon. Wearing flats causes additional bending in the foot. This can be painful for the high-heel wearer who is not accustomed to the resulting flexion. One
effective strategy is to reduce the heel size of shoes gradually. This allows the tendon to slowly stretch and increase its range of motion.