You
can feel your Achilles tendon beneath the skin on
the back of your ankle. It is a fibrous band of
tissue that connects your calf muscles to your heel
bone (calcaneus), which allows you to lift your
heel off the ground.
Most commonly
an overuse injury, the term Achilles tendinitis
commonly refers to:
Acute
inflammation in the sheath surrounding your tendon;
Chronic
damage to the tendon itself, called tendinosis;
A
combination of the two.
Achilles tendinitis can range from mild inflammation
to, in rare cases, a tendon rupture. One type of
tendinitis, called insertional Achilles tendinitis,
can affect the end of the tendon where it attaches
to your heel bone. Achilles tendinitis also can
be associated with other foot problems, such as
painful flat feet.
Unusual use or overuse of the lower leg muscles
and Achilles tendon is usually the cause of Achilles
tendinitis. Repetitive jumping, kicking, and sprinting
can lead to Achilles tendinitis in both recreational
and competitive athletes. Runners, dancers, and
athletes over age 65 are especially at risk. Sudden
increases in training or competition can also inflame
your Achilles tendon. For example, adding hills,
stair-climbing, or sprinting to your running workout
puts extra stress on your Achilles tendon. Improper
technique during training can also strain the tendon.
Intense running or jumping without stretching and
strengthening your lower leg muscles can put you
at risk regardless of your age or fitness level.
Running on tight, exhausted, or fatigued calf muscles
can put added stress on your Achilles tendon, as
your tendon may not be ready to quickly start a
workout after a period of inactivity. Direct blows
or other injuries to the ankle, foot, or lower leg
may pull your Achilles tendon too far and stretch
the tissue. A hard contraction of the calf muscles,
such as can happen when you push for the final sprint
in a race, can strain the tendon. People whose feet
roll inward, a condition called overpronation, are
particularly at risk. Sometimes, shoes with too
much heel cushioning put extra strain on the Achilles
tendon.
Considerations
The time it takes to treat Achilles tendinitis
without surgery is highly variable, as you may
be able to recover faster from tendinitis caused
by a direct blow than you can from an overuse
injury. Surgery is typically considered if your
Achilles tendinitis has not healed after six to
12 months of non-surgical treatment. It is important
to visit your physician to rule out other foot
problems. Several conditions like plantar fasciitis,
stress fractures, heel bursitis and arthritis
may be contributing to your foot pain. If left
untreated, Achilles tendinitis usually worsens
into a chronically painful condition that increases
the risk of tendon rupture. This chronic condition
is known as tendinitis. Many people mistakenly
believe they can play through the pain, but tendinitis
can become a serious injury if not treated properly.
Resuming activities too soon may increase your
healing time and put you at risk for repeated
tendon injuries.
Though many people with
mild or moderate Achilles tendinitis feel they
can treat themselves at home, an evaluation by
a physician usually is the best course of action.
Because several conditions - such as heel bursitis
and tendon tears - have similar symptoms, your
physician can check for complications and decide
on a specific treatment program for your tendinitis.
There usually are three parts to an orthopedic
evaluation: medical history, a physical examination,
and tests that your doctor may order.
MEDICAL HISTORY
Your physician likely will ask about your activities,
which may have caused the tendinitis. You may
be asked when the soreness or pain began. If you
have had any prior Achilles tendon injuries, your
physician will ask about the treatments you have
tried in the past. You may be asked how long your
Achilles tendon has hurt, and whether you were
able to continue playing after you noticed the
pain. Your physician may also inquire about your
training activity. Physicians also typically ask
about other conditions, such as diabetes and allergies,
and medications currently being taken. You also
may be asked about your physical and athletic
goals - information that will help decide what
treatment might be best for you and perhaps allow
you to achieve those goals.
PHYSICAL
EXAM
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.
