Achilles Tendon Problems
What is the Achilles Tendon?
A tendon is a band of tissue that connects a muscle to a bone. The Achilles
tendon, the longest tendon in the body, runs down the back of the lower
leg and connects the calf muscle to the heel bone. Also called the "heel
cord," the Achilles tendon facilitates walking by helping to raise
the heel off the ground.
Achilles Tendonitis and Achilles Tendonosis
Two common disorders that occur in the heel cord are Achilles tendonitis
and Achilles tendonosis. Achilles tendonitis can also be spelled Achilles
tendinitis.
Achilles tendonitis is an inflammation of the Achilles tendon. This inflammation
is typically short- lived. Over time the condition usually progresses
to a degeneration of the tendon, Achilles tendonosis, in which the tendon
loses its organized structure and is likely to develop microscopic tears.
Sometimes the degeneration involves the site where the Achilles tendon
attaches to the heel bone. In rare cases, chronic degeneration with or
without pain may result in rupture of the tendon.
Symptoms
The symptoms associated with Achilles tendonitis and tendonosis include:
- There is pain, aching, stiffness, soreness, or tenderness within the tendon.
This may occur anywhere along the tendon's path, beginning with the
narrow area directly above the heel and extending upward to the region
just below the calf muscle. Often pain appears upon arising in the morning
or after periods of rest, then improves somewhat with motion. But later
worsens with increased activity.
- There is tenderness, or sometimes intense pain, when the sides of the tendon
are squeezed.
- There is less tenderness when pressing directly on the back of the tendon.
When the disorder progresses to degeneration, the tendon may become enlarged
and may develop nodules in the area where the tissue is damaged.
Causes
As with "overuse" disorders, Achilles tendonitis and tendonosis
are usually caused by a sudden increase of a repetitive activity involving
the Achilles tendon. Such activity puts too much stress on the tendon
too quickly, leading to micro-injury of the tendon fibers. Due to this
ongoing stress on the tendon, the body is unable to repair the injured
tissue. The structure of the tendon is then altered, resulting in continued
pain. Athletes are at high risk for developing disorders of the Achilles
tendon. Achilles tendonitis and tendonosis are also common in individuals
whose work puts stress on their ankles and feet, such as laborers, as
well as in "weekend warriors", those who are less conditioned
and participate in athletics only on weekends or infrequently. People
with excessive flattening of the arch (pronation) have a tendency to develop
Achilles tendonitis and tendonosis due to the greater demands placed on
the tendon when walking. If these individuals wear shoes without adequate
stability, their over-pronation could further aggravate the Achilles tendon.
Treatment
Treatment approaches for Achilles tendonitis or tendonosis are selected
on the basis of how long the injury has been present and the degree of
damage to the tendon. In the early stage, when there is acute inflammation,
one or more of the following options may be recommended:
- Immobilization. Immobilization may involve the use of a cast or removable
walking boot to reduce forces through the Achilles tendon and promote healing.
- Ice. To reduce swelling due to inflammation, apply Zip Lock bag of ice
over a thin towel to the affected area for 20 minutes of each waking hour.
Do not put ice directly against the skin.
- Oral medications. Non-steroidal anti-inflammatory drugs (NSAIDs), such
as ibuprofen, may be helpful in reducing the pain and inflammation in
the early stage of the condition. Physical therapy.
- Physical therapy may include strengthening exercises, soft-tissue massage/mobilization,
gait and running re-education, stretching and ultrasound therapy.
- Orthotics. Foot orthotics will heel elevation relieves the stress on the tendon.
- If non-surgical approaches fail to restore the tendon to its normal condition,
surgery may be necessary.
Prevention
To prevent Achilles tendonitis or tendonosis from recurring after surgical
or non-surgical treatment, strengthening and stretching of the calf muscles
through daily exercises may be recommended. Wearing proper shoes for the
foot type and activity is also important in preventing recurrence of the
condition.