Achilles 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.
Achilles tendonitis is an overuse injury that is common especially to joggers and jumpers, due to the repetitive action and so may occur in other activities that requires the same repetitive action.
Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or ageing. Anyone can have a tendon injury, but people who make the same motions over and over in their jobs,
sports, or daily activities are more likely to damage a tendon. A tendon injury can happen suddenly or little by little. You are more likely to have a sudden injury if the tendon has been weakened
over time. Common causes of Achilles tendonitis include, over-training or unaccustomed use,?too much too soon?. Sudden change in training surface e.g. grass to bitumen. Flat (over-pronated) feet,
High foot arch with tight Achilles tendon. tight hamstring (back of thigh) and calf muscles, toe walking (or constantly wearing high heels). Poorly supportive footwear, hill running. Poor eccentric
Symptoms vary because you can injure various areas of the muscle-tendon complex. The pain may be an acute or chronic sharp, stabbing, piercing, shooting, burning or aching. It is often most
noticeable immediately after getting out of bed in the morning, or after periods of inactivity, like sitting down for lunch. After a couple minutes of walking around, it will often then settle down
somewhat, before becoming symptomatic again after excessive time standing or walking. But regardless of how the pain is perceived, Achilles tendon pain should not be left untreated due to the danger
that the tendon can become weak, frayed, thickened, and eventually it may rupture.
Physicians usually pinch your Achilles tendon with their fingers to test for swelling and pain. If the tendon itself is inflamed, your physician may be able to feel warmth and swelling around the
tissue, or, in chronic cases, lumps of scar tissue. You will probably be asked to walk around the exam room so your physician can examine your stride. To check for complete rupture of the tendon,
your physician may perform the Thompson test. Your physician squeezes your calf; if your Achilles is not torn, the foot will point downward. If your Achilles is torn, the foot will remain in the same
position. Should your physician require a closer look, these imaging tests may be performed. X-rays taken from different angles may be used to rule out other problems, such as ankle fractures. MRI
(magnetic resonance imaging) uses magnetic waves to create pictures of your ankle that let physicians more clearly look at the tendons surrounding your ankle joint.
As with most soft tissue injuries the initial treatment is RICE - Rest, Ice, Compression and Elevation. In the early phase you?ll be unable to walk without a limp, so your Achilles tendon needs some
active rest from weight-bearing loads. You may need to be non or partial-weight-bearing, utilise crutches, a wedged achilles walking boot or heel wedges to temporarily relieve some of the pressure on
the Achilles tendon. Your physiotherapist will advise you on what they feel is best for you. Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes
each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot. Anti-inflammatory medication (if tolerated) and natural substances eg arnica may help reduce your pain
and swelling. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain
reducing medication. As you improve a kinesio style supportive taping will help to both support the injured soft tissue.
Histological and biological studies on tendon healing have made it possible to envisage surgical repair using a percutaneous approach, with the following objectives, a minimal, and not very
aggressive, operation, which is quick and easy and within the capabilities of all surgeons, the shortest hospitalisation period possible, above all, early and effective re-education, providing a
satisfactory result both in terms of solidity and the comfort of the patient. The percutaneous tenosynthesis TENOLIG combines stability, reliability, patient comfort and lower overall social and
professional costs for this type of lesion.
Maintaining strength and flexibility in the muscles of the calf will help reduce the risk of tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis.