is a condition of irritation and inflammation of the large tendon in the back of the ankle. Achilles tendonitis is a common injury that tends to occur in recreational athletes. Overuse of the
Achilles tendon can cause inflammation that can lead to pain and swelling. Achilles tendonitis is differentiated from another common Achilles tendon condition called Achilles tendinosis. Patients
with Achilles tendinosis have chronic Achilles swelling and pain as a result of degenerative, microscopic tears within the tendon.
Achilles tendonitis is a common sports injury caused by repeated or intense strain on the tendon. But non-athletes also can get it if they put a lot of stress on their feet. Other things that
contribute to Achilles tendonitis include. An increase in activity. Starting a training program after a period of inactivity or adding miles or hills to a jogging regimen are two examples of things
that put people at risk for Achilles tendonitis. Sports that require sudden starts and stops; for example, tennis and basketball. A change in footwear, or wearing old or badly fitting shoes. New
shoes, worn-out shoes, or the wrong size shoes can cause a person's feet to overcompensate and put stress on the Achilles tendon. Additionally, wearing high heels all the time can cause the tendon
and calf muscles to get shorter, and the switch to flat shoes and exercise can put extra strain on the heel. Running up hills. Going uphill forces the Achilles tendon to stretch beyond its normal
range. Weak calf muscles, flat arches, "overpronation" (feet that roll in when running), or "oversupination" (feet that roll out when running). Overpronation and oversupination make the lower leg
rotate and put a twisting stress on the tendon. Exercising without warming up. Tight calf muscles or muscles that lack flexibility decrease a person's range of motion and put an extra strain on the
tendon. Running or exercising on a hard or uneven surface or doing lunges or plyometrics without adequate training. A traumatic injury to the Achilles tendon.
Morning pain is a hallmark symptom because the achilles tendon must tolerate full range of movement including stretch immediately on rising in the morning. Symptoms are typically localized to the
tendon and immediate surrounding area. Swelling and pain at the attachment are less common. The tendon can appear to have subtle changes in outline, becoming thicker in the A-P and M-L planes. With
people who have a tendinopathy of the achilles tendon that has a sensitive zone, combined with intratendinous swelling, that moves along with the tendon and of which sensitivity increases or
decreases when the tendon is put under pressure, there will be a high predictive value that in this situation there is a case of tendinosis.
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.
There are many nonsurgical ways for treating both forms of tendinitis like resting, putting ice on the area and exercises. Healing of the Achilles tendon can be a slow process, because the area has
poor blood supply. If the condition becomes chronic and symptoms do not improve within 6 months, surgery might be needed. Surgical treatment may be suggested if pain has not improved after six months
of nonsurgical care.
Percutaneous Achilles Tendon Surgery. During this procedure the surgeon will make 3 to 4 incisions (approx. 2.5 cm long) on both sides of the Achilles tendon. Small forceps are used to free the
tendon sheath (the soft tissue casing around your Achilles tendon) to make room for the surgeon to stitch/suture any tears. Skilled surgeons may perform a percutaneous achilles tendon surgery with
ultrasound imaging techniques to allow for blink suturing with stab incisions made by a surgical suture needle. This procedure can be done in 3 different ways depending on the preference and
experience of your surgeon. Instead of making several 2.5 cm incisions for this procedure, some surgeons will use guided imaging with an ultrasound to see the Achilles tendon tissue without having to
open up your ankle. For this technique, they will use a surgical needle to repeatedly stab your Achilles tendon. These "stab incisions" will allow the surgeon to "blindly" suture your tendon without
seeing the actual tissue. As another option - some surgeons will only make 1 to 3 incisions for smaller surgical implements to repair your tendon while relying on imaging ultrasound to see your
damaged tissue. During either procedure the use of ultrasound imaging or endoscopic techniques requires a very skilled surgeon.
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).