Achilles tendonitis is an
iInflammation in the tendon of the calf muscle, where it attaches to the heel bone. Achilles tendonitis causes pain and stiffness at the back of the leg, near the heel. Achilles tendonitis can be
caused by overuse of the Achilles tendon, overly tight calf muscles or Achilles tendons, excess uphill running, a sudden increase in the intensity of training or the type of shoes worn to run, or
wearing high heels at work and then switching to a lower-heeled workout shoe. Achilles tendonitis causes pain, tenderness, and often swelling over the Achilles tendon. There is pain on rising up on
the toes and pain with stretching of the tendon. The range of motion of the ankle may be limited. Treatment includes applying ice packs to the Achilles tendon, raising the lower leg, and taking an
anti-inflammatory medication. In some severe cases of Achilles tendonitis, a cast may be needed for several weeks. A heel lift insert may also be used in shoes to prevent future overstretching of the
Achilles tendon. Exerting rapid stress on the Achilles tendon when it is inflamed can result in rupture of the tendon.
Tight or tired calf muscles, which transfer too much of the force associated with running onto the Achilles tendon. Not stretching the calves properly or a rapid increase in intensity and frequency
of sport training can make calf muscles fatigued. Activities which place a lot of stress on the achilles tendon, such as hill running and sprint training, can also cause Achilles Tendinitis. Runners
who overpronate (roll too far inward on their feet during impact) are most susceptible to Achilles Tendinitis. Runners with flat feet are susceptible to Achilles Tendinitis because flat feet cause a
'wringing out' effect on the achilles tendon during running. High arched feet usually absorb less shock from the impact of running so that shock is transferred to the Achilles tendon. Use of
inappropriate footwear when playing sport or running e.g., sandals, can also put an extra load on the Achilles tendon. Shoes are now available that have been designed for individual sports and
provide cushioning to absorb the shock of impact and support for the foot during forceful movements. Training on hard surfaces e.g., concrete, also increases the risk of Achilles Tendinitis. Landing
heavily or continuously on a hard surface can send a shock through the body which is partly absorbed by the Achilles tendon. A soft surface like grass turf helps to lessen the shock of the impact by
absorbing some of the force of the feet landing heavily on the ground after a jump or during a running motion.
The pain associated with Achilles tendinitis typically begins as a mild ache in the back of the leg or above the heel after running or other sports activity. Episodes of more severe pain may occur
after prolonged running, stair climbing or sprinting. You might also experience tenderness or stiffness, especially in the morning, which usually improves with mild activity. If you experience
persistent pain around the Achilles tendon, call your doctor. Seek immediate medical attention if the pain or disability is severe. You may have a torn (ruptured) Achilles tendon.
If Achilles tendonitis is suspected, avoid any exercise or activity that causes the pain. It is advisable to see a doctor promptly so that an accurate diagnosis can be made and appropriate treatment
recommended. The doctor will take a full medical history and will ask about the nature and duration of the symptoms. They will perform a physical examination of the affected area. Ultrasound scanning
may be used to assess damage to the tendon or surrounding structures. Occasionally MRI (magnetic resonance imaging) may be recommended. The symptoms of Achilles tendonitis are often similar to
symptoms of other conditions such as partial Achilles tendon rupture and heel bursitis. This can make diagnosis difficult and a referral to an orthopaedic specialist may be required in order for an
accurate diagnosis to be made.
There is insufficient evidence from randomised controlled trials to determine which method of treatment is the most appropriate for the treatment of acute or chronic Achilles tendonitis. The patient
should abstain from aggravating activities, but with a minimum of rest in order to preserve overall fitness. Possible treatments are non-steroidal anti-inflammatory drugs (NSAIDs), ice, rest,
increased warm-up/stretching exercises, physiotherapy and heel lifts (orthotic devices - used on both sides to prevent a gait imbalance). Other treatments evaluated in a Cochrane review were heparin,
steroid injections, glycosaminoglycan sulfate, Actovegin?, and topical laser treatment. There was no clear evidence of benefit from these. Casting is an option for resistant Achilles tendonitis.
Drugs - analgesics and NSAIDs. Surgery is sometimes used for resistant Achilles tendonitis, but usually as a last resort. Other recently reported treatments include continuing sporting activity in
conjunction with rehabilitation, low-energy shock wave therapy and topical glyceryl trinitrate .
Surgery for an Achilles tendon rupture can be done with a single large incision, which is called open surgery. Or it can be done with several small incisions. This is called percutaneous surgery. The
differences in age and activity levels of people who get surgery can make it hard to know if Achilles tendon surgery is effective. The success of your surgery can depend on, your surgeon's
experience. The type of surgery you have. How damaged the tendon is. How soon after rupture the surgery is done. How soon you start your rehab program after surgery. How well you follow your rehab
program. Talk to your surgeon about his or her surgical experience. Ask about his or her success rate with the technique that would best treat your condition.
While it may not be possible to prevent Achilles tendinitis, you can take measures to reduce your risk. Increase your activity level gradually. If you're just beginning an exercise regimen, start
slowly and gradually increase the duration and intensity of the training. Take it easy. Avoid activities that place excessive stress on your tendons, such as hill running. If you participate in a
strenuous activity, warm up first by exercising at a slower pace. If you notice pain during a particular exercise, stop and rest. Choose your shoes carefully. The shoes you wear while exercising
should provide adequate cushioning for your heel and should have a firm arch support to help reduce the tension in the Achilles tendon. Replace your worn-out shoes. If your shoes are in good
condition but don't support your feet, try arch supports in both shoes. Stretch daily. Take the time to stretch your calf muscles and Achilles tendon in the morning, before exercise and after
exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendinitis. Strengthen your calf muscles. Strong calf muscles enable the calf and Achilles tendon to
better handle the stresses they encounter with activity and exercise. Cross-train. Alternate high-impact activities, such as running and jumping, with low-impact activities, such as cycling and