Achilles tendonitis, also
sometimes called Achilles tendinitis, is a painful and often debilitating inflammation of the Achilles tendon (heel cord). The Achilles tendon is the largest and strongest tendon in the body. It is
located in the back of the lower leg, attaches to the heel bone (calcaneus), and connects the leg muscles to the foot. The Achilles tendon gives us the ability to rise up on our toes, facilitating
the act of walking, and Achilles tendonitis can make walking almost impossible. There are three stages of tendon inflammation, Peritenonitis, Tendinosis, Peritenonitis with tendinosis. Peritenonitis
is characterized by localized pain during or following activity. As this condition progresses, pain often develops earlier on during activity, with decreased activity, or while at rest. Tendinosis is
a degenerative condition that usually does not produce symptoms (i.e., is asymptomatic). It may cause swelling or a hard knot of tissue (nodule) on the back of the leg. Peritenonitis with tendinosis
results in pain and swelling with activity. As this condition progresses, partial or complete tendon rupture may occur. The overall incidence of Achilles tendonitis is unknown. The condition occurs
in approximately 6-18% of runners, and also is more common in athletes, especially in sports that involve jumping (e.g., basketball), and in people who do a lot of walking. Achilles tendonitis that
occurs as a result of arthritis in the heel is more common in people who are middle aged and older.
Most common in middle-aged men. Conditions affecting the foot structure (such as fallen arches). Running on uneven, hilly ground, or in poor quality shoes. Diabetes. High blood pressure. Certain
antibiotics. ?Weekend Warriors?. Recent increase in the intensity of an exercise program. While Achilles tendinitis can flare up with any overuse or strain of the Achilles tendon, it most often
affects middle-aged men, especially if they are ?weekend warriors? who are relatively sedentary during the week, then decide to play basketball or football on Saturday. Those with flat feet or other
structural conditions affecting their feet tend to put excess strain on the Achilles tendon, increasing their chances of developing Achilles tendinitis or even rupturing the tendon. If you are a
runner, be sure to only run in quality running shoes that are supportive and well cushioned, and to be mindful of the surface you?re running on. Uneven surfaces and especially hilly terrain put
additional strain on your Achilles tendon and can lead to the condition.
Morning pain is a hallmark symptom because the achilles tendon must tolerate full range of movement including stretch immediately on rising in the morning. Symptoms are typically localized to the
tendon and immediate surrounding area. Swelling and pain at the attachment are less common. The tendon can appear to have subtle changes in outline, becoming thicker in the A-P and M-L planes. With
people who have a tendinopathy of the achilles tendon that has a sensitive zone, combined with intratendinous swelling, that moves along with the tendon and of which sensitivity increases or
decreases when the tendon is put under pressure, there will be a high predictive value that in this situation there is a case of tendinosis.
A doctor or professional therapist will confirm a diagnosis, identify and correct possible causes, apply treatment and prescribe eccentric rehabilitation exercises. An MRI or Ultrasound scan can
determine the extent of the injury and indicate a precise diagnosis. Gait analysis along with a physical assessment will identify any possible biomechanical factors such as over pronation which may
have contributed to the achilles tendonitis and training methods will be considered. Biomechanical problems can be corrected with the use of orthotic inserts and selection of correct footwear.
The initial aim of the treatment in acute cases is to reduce strain on the tendon and reduce inflammation until rehabilitation can begin. This may involve, avoiding or severely limiting activities
that may aggravate the condition, such as running or uphill climbs. Using shoe inserts (orthoses) to take pressure off the tendon. Wear supportive shoes. Reducing Inflammation by icing. Taking
non-steroidal anti-inflammatory drugs. Heel cups and heel lifts can be used temporarily to take pressure off the tendon, but must not be used long term as it can lead to a shortening of the calf.
Calf Compression Sleeves. Placing the foot in a cast or restrictive ankle-boot to minimize movement and give the tendon time to heal. This may be recommended in severe cases and used for about eight
If non-surgical approaches fail to restore the tendon to its normal condition, surgery may be necessary. The foot and ankle surgeon will select the best procedure to repair the tendon, based upon the
extent of the injury, the patient?s age and activity level, and other factors.
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,