So basically what is Achilles tendinitis? It is actually a band that connects our heel bone to the calf muscles of the leg.It is the main tendon that we rely upon for walking and running. Once this band of tissue or tendon gets inflamed, it causes pain or tendinitis. In fact, it is the biggest and strongest tendon in the body.There are two types of tendinitis – Insertional and Noninsertional. The pathology is not inflammatory, it is a gradual failed healing process. The pain occurs due to the tendons response to injury. Pain in Achilles tendon is relatively common in people who are into physical activity like exercises, sports recreational activities and even in individuals who are also inactive. It is one of the most common injuries in recreational runners.
The prevalence of Achilles tendinitis is found mainly between the age group of 30 -40 years. As we age, the chances of having Achilles also increases. It is more common especially in male gender and individuals who are into sports and who are indulge in highly active sport games like dancing, volleyball, dancing, gymnastics. Congenital abnormality also causes a greater risk which can cause stress on the the tendons.
As it is the main muscle which is used during running and walking. So the cause of the pain occurs due to overworking or overstressing that area of the tendon during our high intense workouts. Overuse and a recently caused trauma in the Achilles tendon can also aggravate severe pain due to the constant repetitive eccentric load-induced microtrauma that stresses the structures around the tendon. Many other risk factors can also predispose to Achilles tendons such as:
It is more common in men and old age group of people
Individuals with tight calf muscles which can stress on the tendon area.
Women who wear high heels because bone spurs on the heel which can rub against the tendon.
Many medications such as fluoroquinolones have found to be associated with it.
Increased intensity during running,jumping.
People with anatomical flat foot.
Pain starts especially in the morning.
It gets worse when you are active and goes down to the back of the leg near the heel area.
There will be difficulty in flexing the affected foot.
A sharp, shooting ‘pop’ pain will occur especially during exercising which suggests a rupture tendon.
While palpating with our fingers, a mild swelling can be seen in the affected area
swelling is associated with warmth and redness.
Unable to rise up on your toes can also require urgent medical attention.
Diagnosis is the most crucial step as it can be mistaken for a sprained ankle. Various steps should be considered such as:
Overall medical history with physical examination by the doctor.
Symptoms should be described with details.
Various test such as – Inspection, palpation of the affected area is done such as ankle’s range of motion such as Thompson test, Calf squeeze test.
Bone spurs, pain and swelling examination will be done thoroughly by the doctor.
IMAGING TESTS –
X-rays – are not typically used to diagnose but it is helpful in identifying the underlying cause which causes pain such as if there is any bony overgrowth in the heel area.
MRI- it can provide excellent details of the soft tissue such as tendon or micro-tears called as tendon ruptures.
ULTRASOUND- It helps in viewing the tendon during its movement and when used with color Doppler effects – blood flow can also be assessed.
TREATMENT AND DRUGS:
The first step is to minimize inflammation and stress on the tendon by conservative management
REST – Avoid running or walking until all tenderness has gone. Cycling or swimming can be a good replacement.
STRENGTHENING- Gentle calf stretching can be done and special exercises such as eccentric calf raises by contracting the calf muscles.
High intensity filled weight bearing activities should be stopped.
Ice packs can be used to control swelling for 24 hours.
Heel raise or orthotics may be useful
Start wearing shoes with fitted soles.
Night splints can be worn at night to prolong the stretch of the tendon.
Transdermal nitroglycerine patches can also be worn in severe cases.
Cross friction massages as well as iontophoresis is done into the skin into the Achilles tendon to provide relief.
Cold level laser therapy as well as Extracorpeal shockwave therapy can also be included.
Anti-inflammatory painkillers such asNon-steroidalanti-inflammatory drugs (NSAIDS) like ibuprofen and naproxen and COX-2 inhibitors will provide relief from pain and swelling.However, home care methods will work the best. It is highly suggested to consult an an orthopedics or a physiotherapist for the required steps to be taken.
As they say prevention is better than cure. First thing we can do is to wear properly fitted sport shoe that roll inwards.
Before doing any exercise, warm up and stretching is required.
Always increase the intensity of workout gradually.
Various calf muscle strengthening exercises can be done.
Make sure to only wear shoes with no or less heel.
Hamstring muscles should be made flexible by stretching it.