What Will Cause Achilles Tendonitis

Overview
Inflammation of the Achilles tendon.The Achilles is the large tendon connecting the two major calf muscles, gastrocnemius and soleus, to the back of the heel bone. Under too much stress, the tendon tightens and is forced to work too hard. This causes it to become inflamed (that is tendinitis), and, over time, can produce a covering of scar tissue, which is less flexible than the tendon. If the inflamed Achilles continues to be stressed, it can tear or rupture.

Causes
The calf is under a lot of strain when running: it is not only put on stretch during landing of the foot, but it also has to produce the tension needed to support body weight and absorb the shock of landing. This is what is called an ?eccentric load?. Excessive eccentric loading - either by way of a dramatic increase in mileage, or excessive hill running, or faulty running posture - could very well be the cause of a runner?s achilles tendinitis. The calf strain translates downward into the achilles tendon where it attaches to the heel, and inflammation ensues. Inflammation then causes scarring and fibrosis of tissues, which in turn inflicts pain upon stretching or use. Risk factors for Achilles tendinitis also include spending prolonged amounts of time standing or walking.

Symptoms
Patients with an Achilles tendon rupture frequently present with complaints of a sudden snap in the lower calf associated with acute, severe pain. The patient reports feeling like he or she has been shot, kicked, or cut in the back of the leg, which may result in an inability to ambulate further. A patient with Achilles tendon rupture will be unable to stand on his or her toes on the affected side. Tendinosis is often pain free. Typically, the only sign of the condition may be a palpable intratendinous nodule that accompanies the tendon as the ankle is placed through its range of motion (ROM). Patients with paratenonitis typically present with warmth, swelling, and diffuse tenderness localized 2-6 cm proximal to the tendon's insertion. Paratenonitis with tendinosis. This is diagnosed in patients with activity-related pain, as well as swelling of the tendon sheath and tendon nodularity.

Diagnosis
A podiatrist can usually make the diagnosis by clinical history and physical examination alone. Pain with touching or stretching the tendon is typical. There may also be a visible swelling to the tendon. The patient frequently has difficulty plantarflexing (pushing down the ball of the foot and toes, like one would press on a gas pedal), particularly against resistance. In most cases X-rays don't show much, as they tend to show bone more than soft tissues. But X-rays may show associated degeneration of the heel bone that is common with Achilles Tendon problems. For example, heel spurs, calcification within the tendon, avulsion fractures, periostitis (a bruising of the outer covering of the bone) may all be seen on X-ray. In cases where we are uncertain as to the extent of the damage to the tendon, though, an MRI scan may be necessary, which images the soft tissues better than X-rays. When the tendon is simply inflamed and not severely damaged, the problem may or may not be visible on MRI. It depends upon the severity of the condition.

Nonsurgical Treatment
The main treatments for Achilles tendinitis do not involve surgery. It is important to remember that it may take at least 2 to 3 months for the pain to go away. Try putting ice over the Achilles tendon for 15 to 20 minutes, two to three times per day. Remove the ice if the area gets numb. Changes in activity may help manage the symptoms. Decrease or stop any activity that causes you pain. Run or walk on smoother and softer surfaces. Switch to biking, swimming, or other activities that put less stress on the Achilles tendon. Your health care provider or physical therapist can show you stretching exercises for the Achilles tendon. They may also suggest the following changes in your footwear, a brace or boot or cast to keep the heel and tendon still and allow the swelling to go down, heel lifts placed in the shoe under the heel, shoes that are softer in the areas over and under the heel cushion. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen can help with pain or swelling. Talk with your health care provider. If these treatments do not improve symptoms, you may need surgery to remove inflamed tissue and abnormal areas of the tendon. Surgery also can be used to remove the bone spur that is irritating the tendon. Extracorporeal shock wave therapy (ESWT) may be an alternative to surgery for people who have not responded to other treatments. This treatment uses low-dose sound waves.



Surgical Treatment
Occasionally, conservative management of Achilles tendon conditions fails. This failure is more common in older male patients and those with longstanding symptoms, those who persist in full training despite symptoms or those who have uncorrected predisposing factors. In these cases, surgery may be indicated. It should be remembered, however, that the rehabilitation program, particularly for severe Achilles tendon injuries, is a slow, lengthy program. Surgery is only indicated when there is failure to progress in the rehabilitation program. Surgery should not be considered unless at least six months of appropriate conservative management has failed to lead to improvement.

Prevention
Stay in good shape year-round and try to keep your muscles as strong as they can be. Strong, flexible muscles work more efficiently and put less stress on your tendon. Increase the intensity and length of your exercise sessions gradually. This is especially important if you've been inactive for a while or you're new to a sport. Always warm up before you go for a run or play a sport. If your muscles are tight, your Achilles tendons have to work harder to compensate. Stretch it out. Stretch your legs, especially your calves, hamstrings, quadriceps, and thigh muscles - these muscles help stabilize your knee while running. Get shoes that fit properly and are designed for your sport. If you're a jogger, go to a running specialty store and have a trained professional help you select shoes that match your foot type and offer plenty of support. Replace your shoes before they become worn out. Try to run on softer surfaces like grass, dirt trails, or synthetic tracks. Hard surfaces like concrete or asphalt can put extra pressure on the joints. Also avoid running up or down hills as much as possible. Vary your exercise routine. Work different muscle groups to keep yourself in good overall shape and keep individual muscles from getting overused. If you notice any symptoms of Achilles tendonitis, stop running or doing activities that put stress on your feet. Wait until all the pain is gone or you have been cleared to start participating again by a doctor.