Achilles tendonitis is inflammation and tendonosis is degeneration and irregular healing of the achilles tendon. The achilles tendon is the large tendon located in the back of
the leg that inserts into the heel. The pain caused by achilles tendonitis/osis can develop gradually without a history of trauma. The pain can be a shooting pain, burning pain, or even an extremely
piercing pain. Achilles tendonitis/osis should not be left untreated due to the danger that the tendon can become weak and rupture requiring surgery.
Like any muscle or tendon in the body, the older we get, the more likely we are to sustain an injury. So middle-aged men and women are most at risk, with a slightly higher risk factor attributed to
males. Those who participate in more intense athletic activities like high impact sports (tennis, running, basketball) are most susceptible to the injury. Certain underlying medical conditions can
also be a contributing factor. Diabetics are more at risk of suffering from Achilles Tendinitis, as are those who are not in great physical shape. Some antibiotics, particularly fluoroquinolones can
make one more likely to suffer a strained Achilles Tendon.
Symptoms of Achilles tendonitis include, pain in the back of the heel, difficulty walking, sometimes the pain makes walking impossible, swelling, tenderness and warmth of the Achilles tendon.
Achilles tendonitis is graded according to how severe it is, mild - pain in the Achilles tendon during a particular activity (such as running) or shortly after. Moderate - the Achilles tendon may
swell. In some cases, a hard lump (nodule) may form in the tendon. Severe - any type of activity that involves weight bearing causes pain of the Achilles tendon. Very occasionally, the Achilles
tendon may rupture (tear). When an Achilles tendon ruptures, it is said to feel like a hard whack on the heel.
X-rays are usually normal in patients with Achilles tendonitis, but are performed to evaluate for other possible conditions. Occasionally, an MRI is needed to evaluate a patient for tears within the
tendon. If there is a thought of surgical treatment an MRI may be helpful for preoperative evaluation and planning.
Treatment options might include anti-inflammatory medication such as ibuprofen which might help with acute achilles inflammation and pain but has not been proven to be beneficial long term and may
even inhibit healing. If the injury is severe then a plaster cast might be applied to immobilize the tendon. Use of electrotherapy such as ultrasound treatment, laser therapy and extracorporeal shock
wave therapy (ESWT) may be beneficial in reducing pain and encouraging healing. Applying sports massage techniques can mobilze the tissues or the tendon itself and help stretch the calf muscles. Some
might give a steroid injection however an injection directly into the tendon is not recommended. Some specialists believe this can increase the risk of a total rupture of the tendon in future. One of
the most effective forms of treatment for achilles tendonitis is a full rehabilitation program consisting of eccentric strengthening exercises. There is now considerable evidence suggesting the
effectiveness of slow eccentric rehabilitation exercises for curing achilles tendon pain.
Surgical treatment for tendons that fail to respond to conservative treatment can involve several procedures, all of which are designed to irritate the tendon and initiate a chemically mediated
healing response. These procedures range from more simple procedures such as percutaneous tenotomy61 to open procedures and removal of tendon pathology. Percutaneous tenotomy resulted in 75% of
patients reporting good or excellent results after 18 months. Open surgery for Achilles tendinopathy has shown that the outcomes are better for those tendons without a focal lesion compared with
those with a focal area of tendinopathy.62 At 7 months after surgery, 67% had returned to physical activity, 88% from the no-lesion group and 50% from the group with a focal lesion.
The following measures can significantly reduce the risk of developing Achilles tendonitis. Adequately stretch and warm up prior to exercise. Warm down and stretch after exercise. Choose footwear
carefully and use footwear appropriate to the sport being undertaken. Use orthotic devices in footwear to correctly support the foot. Exercise within fitness levels and follow a sensible exercise
programme. Develop strong, flexible calf muscles.