Achilles tendonitis

Achilles tendonitis is inflammation of the Achilles tendon. In most cases, it is a type of overuse injury and is more common in younger people. Professional and weekend athletes can suffer from Achilles tendonitis, but it is also a common overuse injury in people not involved in sport. Treatment includes rest, non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy and avoiding activities that aggravate the condition.

Tendons explained
A tendon is a band of connective tissue that anchors muscle to bone. The Achilles tendon is the largest tendon in the body. It attaches the calf muscles to the heel bone (calcaneus) and is very important because it lets you lift your heel when you start to walk. It also helps you to walk, run or stand on tiptoe.

Symptoms
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.

• 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.

• Overuse injury – this occurs when the Achilles tendon is stressed until it develops small tears. Runners seem to be the most susceptible. People who play sports that involve jumping, such as basketball, are also at increased risk.
• Arthritis – Achilles tendonitis can be a part of generalised inflammatory arthritis, such as ankylosing spondylitis or psoriatic arthritis. In these conditions both tendons can be affected.
• Foot problems – some people with flat feet or hyperpronated feet (feet that turn inward while walking) are prone to Achilles tendonitis. The flattened arch pulls on calf muscles and keeps the Achilles tendon under tight strain. This constant mechanical stress on the heel and tendon can cause inflammation, pain and swelling of the tendon. Being overweight can make the problem worse.
• Footwear – wearing shoes with minimal support while walking or running can increase the risk, as can wearing high heels.
• Overweight and obesity – being overweight places more strain on many parts of the body, including the Achilles tendon.

• Medical history, including your exercise habits and footwear
• Physical examination, especially examining for thickness and tenderness of the Achilles tendon
• Tests may be required. These may include an x-ray of the foot, ultrasound and occasionally blood tests (to test for an inflammatory condition), and an MRI scan of the tendon.

• Avoiding or severely limiting activities that may aggravate the condition, such as running
• Using shoe inserts (orthoses) to take pressure off the tendon as it heals. In cases of flat or hyperpronated feet, your doctor or podiatrist may recommend long-term use of orthoses.

• Applying icepacks for 20 minutes per hour during the acute stage
• Taking non-steroidal anti-inflammatory drugs
• Placing the foot in a cast or restrictive ankle-boot to minimise movement and give the tendon time to heal. This may be recommended in severe cases and used for about eight weeks.

• Incorporate stretching into your warm-up and cool-down routines.
• Maintain an adequate level of fitness for your sport.
• Avoid dramatic increases in sports training.
• If you experience pain in your Achilles tendon, rest the area. Trying to ‘work through’ the pain will only make your injury worse.
• Wear good quality supportive shoes appropriate to your sport. If there is foot deformity or flattening, obtain orthoses.
• Avoid wearing high heels on a regular basis. Maintaining your foot in a ‘tiptoe’ position shortens your calf muscles and reduces the flexibility of your Achilles tendon. An inflexible Achilles tendon is more susceptible to injury.
• Maintain a normal healthy weight.

• Your doctor
• Podiatrist
• Physiotherapist

• In most cases, Achilles tendonitis is a type of overuse injury that is more common among athletes and people who train heavily.
• Treatment includes rest, non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy and avoiding activities that aggravate the condition.
• Surgery is only considered if all other treatment options have failed to cure the condition within six months.

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