Achilles Tendonitis Facts

Overview

Achilles TendonitisTendinitis is the inflammation of a tendon. Tendons are thick cords of tissue that connect muscles to bone. Achilles tendinitis, or an inflammation of the Achilles tendon, is one of the most common causes of foot or ankle pain. Other types of foot/ankle tendinitis include posterior tibial tendinitis and peroneal tendinitis.




Causes

There are a number of ways a person can develop Achilles tendinitis. Some causes are easier to avoid than others, but being aware of them can aid earlier diagnosis and help prevent serious injury. Causes of Achilles tendinitis include, using incorrect or worn out shoes when running or exercising. Not warming up properly before exercise. Increasing intensity of exercise too quickly (e.g. running speed or distance covered). Prematurely introducing hill running or stair climbing to exercise routine. Running on hard or uneven surfaces. Calf muscle is injured or has little flexibility (this puts a lot of strain on the Achilles tendon). Sudden intense physical activity such as sprinting for the finish line. Achilles tendinitis can also be caused by differences in foot, leg or ankle anatomy. For example, some people can have flatness in their foot where there would normally be an arch; this puts more strain on the tendon. The FDA has asked that a boxed warning be added to the prescribing information for fluoroquinolone antibiotics. Patients taking these drugs may experience an increased risk of tendinitis and tendon rupture. Fluoroquinolones include Cipro (ciprofloxacin), Factive (gemifloxacin), Levaquin (levofloxacin), Avelox (moxifloxacin), Noroxin (norfloxacin), Floxin (ofloxacin) and Proquin (ciprofloxacin hydrochloride). It is important to remember that the risk for injury is not necessarily gone when the drug is stopped. Cases have been reported in which tendon problems occurred up to several months after the drug was discontinued.




Symptoms

Recurring localized pain, sometimes severe, along the tendon during or a few hours after running. Morning tenderness about an inch and a half above the point where the Achilles tendon is attached to the heel bone. Sluggishness in your leg. Mild or severe swelling. Stiffness that generally diminishes as the tendon warms up with use.




Diagnosis

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.




Nonsurgical Treatment

Tendon inflammation should initially be treated with ice, gentle calf muscle stretching, and use of NSAIDs. A heel lift can be placed in the shoes to take tension off the tendon. Athletes should be instructed to avoid uphill and downhill running until the tendon is not painful and to engage in cross-training aerobic conditioning. Complete tears of the Achilles tendon usually require surgical repair.

Achilles Tendinitis




Surgical Treatment

Treating this surgically, there are numerous methods to repair the tendon. Most commonly, Achilles tendon is exposed through an incision at the back of the ankle. After identifying both ends of ruptured tendon, the edges got trimmed and then both ends were sutured together with optimal tension. To get a better outcome with fixation, an anchor may have to be in place in calcaneus, provided the rupture is very low. Care must be taken to avoid injuries to the nerves located adjacent to the tendon.




Prevention

To prevent Achilles tendonitis or tendonosis from recurring after surgical or non-surgical treatment, the foot and ankle surgeon may recommend strengthening and stretching of the calf muscles through daily exercises. Wearing proper shoes for the foot type and activity is also important in preventing recurrence of the condition.

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