ACHILLES TENDONITIS AND TENDINOSIS
The Achilles tendon (heel cord) is a strong band of tissue that connects the calf muscle to the heel bone in the back of the leg. The Achilles tendon allows heel raise off the ground during walking.
What is Achilles Tendonitis and Achilles Tendonosis?
Achilles tendonitis is a painful inflammation of the Achilles tendon. It is commonly occur in the region of the least blood circulation of the tendon (about two inches above its insertion into the heel bone). Another common location of Achilles tendonitis is at its insertion site into the heel bone. It is usually self limiting condition, but occasionally this inflammation might progress to degeneration of the tendon with microscopic tears in the tendon fibers. The degeneration of the tendon is called Achilles Tendonosis. Chronic Achilles tendonosis may result in tendon rupture.
Vigorous physical activities and repetitive exercises that involve the Achilles tendon. Flat foot deformity and tight calf muscles are conditions that place high demands on the Achilles tendon exposing it to a higher risk of tendonitis and tendonosis. Some medications like corticosteroids and fluoroquinolone are found to carry high risk of Achilles tendon inflammation and rupture.
Pain and tenderness within the tendon at the site of its attachment to the heel bone or just below the calf muscles. The pain usually occurs upon arising in the morning or after periods of rest, slightly improve with motion but worsens with increased activity.
As damage progresses to tendon degeneration (tendonosis), a nodular enlargement of the tendon may develop in the area where the tissue is damaged.
Your doctor will examine your foot and ankle and evaluate the ankle joint range of motion and condition of the tendon. An x-rays and other imaging modalities might be needed to further asses the condition of the tendon.
The treatment selection of Achilles tendonitis or tendonosis depends on the degree of the tendon damage and the duration of injury. In the early stages of acute tendon injury, the following options may be recommended:
Immobilization. This can be achieved by application of a cast or a removable walking boot to reduce tension forces through the Achilles tendon and promote healing.
Ice. To reduce swelling, application of ice pack to the injured area for 20 minutes after walking will decrease swelling.
Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), may be helpful in reducing the inflammation and the pain.
Heel lift. For those with insertional tendonitis, a heel lift may promotes healing by relaxing the tendon and reducing the tension forces.
Physical therapy. Physical therapy may include stretching and strengthening exercises, soft-tissue massage and ultrasound therapy.
If nonsurgical treatments fail to restore the tendon to its normal condition, surgery may be necessary. Your doctor will select the best procedure to repair the tendon, based on the degree of the injury, your age and activity level, and other factors.
To prevent Achilles tendonitis or tendonosis from recurring after treatment, your doctor may recommend daily strengthening and stretching exercises of the calf muscles. Wearing proper shoes is also important in preventing recurrence of the condition.