tendonitis is inflammation of the tendon, usually resulting from overuse associated with a change in playing surface, footwear or intensity of an activity. The Achilles tendon is surrounded by a
connective tissue sheath (paratenon, or 'paratendon'), rather than a true synovial sheath. The paratenon stretches with movement, allowing maximum gliding action. Near the insertion of the tendon are
two bursae - the subcutaneous calcaneal and the retrocalcaneal bursae.
The majority of Achilles tendon injuries are due to overuse injuries. Other factors that lead to Achilles tendonitis are improper shoe selection, inadequate stretching prior to engaging in athletics,
a short Achilles tendon, direct trauma (injury) to the tendon, training errors and heel bone deformity. There is significant evidence that people with feet that role in excessively (over-pronate) are
at greater risk for developing Achilles tendinitis. The increased pronation puts additional stress on the tendon, therefore, placing it at greater risk for injury.
Mild ache in the back of the lower leg, especially after running. More acute pain may occur after prolonged activity, Tenderness or stiffness in the morning. In most cases the pain associated with
Achilles tendinitis is more annoying than debilitating, making sufferers regret activity after the fact, but not keeping them from doing it. More severe pain around the Achilles tendon may be a
symptom of a much more serious ruptured tendon.
Your physiotherapist or sports doctor can usually confirm the diagnosis of Achilles tendonitis in the clinic. They will base their diagnosis on your history, symptom behaviour and clinical tests.
Achilles tendons will often have a painful and prominent lump within the tendon. Further investigations include US scan or MRI. X-rays are of little use in the diagnosis.
Conservative management of Achilles tendinosis and paratenonitis includes the following. Physical therapy. Eccentric exercises are the cornerstone of strengthening treatment, with most patients
achieving 60-90% pain relief. Orthotic therapy in Achilles tendinosis consists of the use of heel lifts. Nonsteroidal anti-inflammatory drugs (NSAIDs): Tendinosis tends to be less responsive than
paratenonitis to NSAIDs. Steroid injections. Although these provide short-term relief of painful symptoms, there is concern that they can weaken the tendon, leading to rupture. Vessel sclerosis.
Platelet-rich plasma injections. Nitric oxide. Shock-wave therapy. Surgery may also be used in the treatment of Achilles tendinosis and paratenonitis. In paratenonitis, fibrotic adhesions and nodules
are excised, freeing up the tendon. Longitudinal tenotomies may be performed to decompress the tendon. Satisfactory results have been obtained in 75-100% of cases. In tendinosis, in addition to the
above procedures, the degenerated portions of the tendon and any osteophytes are excised. Haglund?s deformity, if present, is removed. If the remaining tendon is too thin and weak, the plantaris or
flexor hallucis longus tendon can be weaved through the Achilles tendon to provide more strength. The outcome is generally less favorable than it is in paratenonitis surgery.
It is important to understand that surgery may not give you 100% functionality of your leg, but you should be able to return to most if not all of your pre-injury activities. These surgical
procedures are often performed with very successful results. What truly makes a difference is your commitment to a doctor recommended rehabilitation program after surgery as there is always a
possibility of re-injuring your tendon even after a surgical procedure. One complication of surgical repair for Achilles tendon tear is that skin can become thin at site of incision, and may have
limited blood flow.
Stretching of the gastrocnemius (keep knee straight) and soleus (keep knee bent) muscles. Hold each stretch for 30 seconds, relax slowly. Repeat stretches 2 - 3 times per day. Remember to stretch
well before running strengthening of foot and calf muscles (eg, heel raises) correct shoes, specifically motion-control shoes and orthotics to correct overpronation. Gradual progression of training
programme. Avoid excessive hill training. Incorporate rest into training programme.