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.
Although a specific incident of overstretching can cause an Achilles tendon disorder, these injuries typically result from a gradually progressive overload of the Achilles tendon or its attachment to
bone. The cause of this chronic overload is usually a combination of factors that can put excess stress on the tendon: being overweight, having a tight calf muscle, standing or walking for a long
period of time, wearing excessively stiff or flat footwear, or engaging in significant sports activity.
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.
Confirming Achilles tendonitis may involve imaging tests. X-rays provide images of the bones of the foot and leg. Magnetic resonance imaging (MRI) is useful for detecting ruptures and degeneration of
tissue. Ultrasound shows tendon movement, related damage, and inflammation.
There are a variety of treatments for Achilles tendonitis. These range from rest and aspirin to steroid injections and surgery. Your doctor might suggest, reducing your physical activity, stretching
and strengthening the calf muscles, switching to a different, less strenuous sport, icing the area after exercise or when in pain, raising your foot to decrease swelling, wearing a brace or
compressive elastic bandage to prevent heel movement, undergoing physical therapy, taking anti-inflammatory medication (e.g., aspirin or ibuprofen) for a limited time, getting steroid injections,
Sometimes more conservative treatments are not effective. In these cases, surgery may be necessary to repair the Achilles tendon. If the condition intensifies and is left untreated, there?s a greater
risk of an Achilles rupture. This can cause sharp pain in the heel area.
Following the MRI or ultrasound scan of the Achilles tendon the extent of the degenerative change would have been defined. The two main types of operation for Achilles tendinosis are either a
stripping of the outer sheath (paratenon) and longitudinal incisions into the tendon (known as a debridement) or a major excision of large portions of the tendon, the defects thus created then being
reconstructed using either allograft (donor tendon, such as Wright medical graft jacket) or more commonly using a flexor hallucis longus tendon transfer. In cases of Achilles tendonosis with more
minor degrees of degenerative change the areas can be stimulated to repair itself by incising the tendon, in the line of the fibres, which stimulates an ingrowth of blood vessels and results in the
healing response. With severe Achilles tendonosis, occasionally a large area of painful tendon needs to be excised which then produces a defect which requires filling. This is best done by
transferring the flexor hallucis longus muscle belly and tendon, which lies adjacent to the Achilles tendon. This results in a composite/double tendon after the operation, with little deficit from
the transferred tendon.
Do strengthening and stretching exercises to keep calf muscles strong and flexible. Keep your hamstring muscles flexible by stretching. Warm up and stretch adequately before participating in any
sports. Always increase the intensity and duration of training gradually. Do not continue an exercise if you experience pain over the tendon. Wear properly fitted running and other sports shoes,
including properly fitted arch supports if your feet roll inwards excessively (over-pronate).