The Orthopaedic Clinic

Achilles Tendinitis


Overview Diagnosis
  Treatment Options

Overview

Achilles tendonitis is inflammation and/or degeneration of the Achilles tendon. The Achilles tendon connects the calf muscles to the heel bone.

The Achilles tendon can become irritated for several reasons including:

  • increasing your speed or running distance too quickly
  • suddenly adding strenuous hills or stair climbing to your exercise routine
  • doing too much too soon after taking time away from exercising
  • a sudden or violent contraction of the calf muscles, such as during an all-out sprint
  • overuse injury
  • lack of flexibility of the calf muscles

    Risk factors that increase your chances of getting Achilles tendonitis include:
  • improper footwear
  • improper warm-up for your activity
  • inflexibility of the calf muscles
  • improper cool down


    Diagnosis

    Symptoms may include:

  • tenderness an inch and a half above the point where the Achilles tendon attaches to the heel bone (noticeable in the morning upon rising)
  • stiffness that gradually eases as the tendon is warmed-up
  • pain after activity that gradually worsens
  • radiating or localized pain along the tendon during and/or after running
  • swelling

    The doctor will ask about your symptoms, exercise habits, and perform a physical exam. He or she may also perform the following tests:
  • x-rays — to see if there is calcium in the tendon
  • magnetic resonance imaging (MRI) scan — to view areas of damage to the tendon

    Treatment Options

    Treatment includes:

  • rest
    Take a break from the activity that caused the tendonitis. Switch to an activity such as swimming that doesn't put stress on the tendon.

  • orthoses
    You may be advised to wear a heel pad or shoe insert that will place your foot in the correct position for walking and running.

  • physical therapy
    You may be directed to undergo physical therapy such as stretching, massage, ultrasound, and strengthening exercises.

  • medications
    Take nonsteroidal anti-inflammatory drugs (NSAID) to ease the pain and decrease inflammation.

    Prevention
    To decrease your chances of experiencing Achilles tendonitis:

  • Take the time to warm-up and cooldown properly.
  • Wear appropriate footwear for your sport.
  • Do not use shoes beyond the recommended duration. This duration will depend on:
              - how frequently you exercise
              - the surface on which you exercise
              - the conditions in which you exercise
  • Gradually add hill work, stairs, speed, and distance to your exercise routine.
  • Stretch and strengthen the calf muscles regularly.

    How Athletes Can Prevent Achilles Tendinitis
    Achilles tendonitis is best prevented by stretching your calf muscles and Achilles tendons before activities. If you have tight Achilles tendons or calf muscles, it is a good idea to stretch these twice a day whether or not you are doing any sports activities that day. If you have a tendency to get Achilles tendonitis, it is a good idea to avoid doing a lot of uphill running.

    Here are six steps to reduce your risk of Achilles tendonitis:
  • Choose your running shoes carefully. They should provide sufficient cushion for the heel strike. Using a prescribed orthotic to change the position of a poorly aligned heel bone may also help. Perhaps the best precaution is to know your limits and to follow a sensible program when you exercise.
  • In addition to custom-fitted orthotics, all runners should be encouraged to wear well-designed shoes that provide good heel stability with a small amount of additional heel lift. This helps to prevent Achilles tendon problems and is especially important in athletes running more than a few miles at a time.
  • Walk and stretch to warm up gradually before running. It’s better to spend few minutes warming up than to spend months on the sidelines with a ruptured Achilles tendon.
  • Focus on stretching and strengthening the muscles in the calf.
  • Increase your running distance and your speed gradually, in increments no greater than 10 percent a week.
  • Avoid unaccustomed strenuous sprinting, such as hill running.
  • Cool down properly by stretching after exercise.

    Improving Sports Performance
    The key to improving sports performance after a diagnosis of Achilles tendonitis is a proper rehabilitation program, and adhering to some of those same principles after the injury is gone.

    The single most important aspect of improving performance is stretching before and after you step onto the field, court, ice, or golf course.

    Benefits derived from stretching include:

  • increased physical efficiency and performance
  • decreased risk of injury
  • increased blood supply and nutrients to joint structures
  • increased coordination
  • improved muscular balance and postural awareness
  • decreased risk of lower-back pain
  • reduced stress
  • enhanced enjoyment

    Rehabilitation for Achilles tendonitis often includes the following:
  • Reduce activity during the acute phase.
  • Ice injury multiple times per day (place foot/ankle in bucket of ice water).
  • Use 1/8" felt pad heel lifts in both shoes until symptoms are gone.
  • Perform gentle exercises, such as hopping on toes or jump roping, to build elasticity in the muscle and tendon. Start minimally, and only after pain is gone.
  • Use anti-inflammatory medications such as ibuprofen to reduce inflammation and speed up recovery.
    The major objectives of rehabilitation from Achilles tendonitis are to improve the elasticity of the calf muscle and to gradually increase pain-free range of motion at the ankle. Exercises to achieve these goals include:

  • Gastrocnemius stretch
    Stand in front of a wall and flatten your palms on the wall, elbows extended. Bend elbows and lean into the wall while keeping back and knees straight and feet flat on the floor. Lean as far into the wall as first significant pain allows, attempting ultimately to rest forehead on the wall. Hold this position for 10 to 20 seconds, then extend elbows while maintaining hand contact with the wall. Rest for five to 10 seconds. Perform this procedure 10 times at least three times daily. While this exercise can be modified to stretch only the injured side, doing both sides is recommended to protect the uninvolved side from injury while rehabilitating the injured tendon.

  • Soleus stretch
    Stand in front of a wall and flatten your palms on the wall, elbows extended. Slightly flex knees but keep back straight. Feet must remain flat on the floor or ground. Lean as far into the wall as first significant pain permits and hold this position for 10 to 20 seconds. Extend the elbows while maintaining hand contact with the wall. Rest for five to 10 seconds. Perform this cycle 10 times at least three times daily. While this exercise can be modified to stretch only the injured side, doing both sides is recommended to protect the uninvolved side from injury while rehabilitating the injured tendon.

  • Foot flexion
    Sit on the floor, extending the injured-side leg and flexing the opposite leg at the knee. Loop a towel under the instep of the injured-side foot while holding an end of the towel in each hand. Gently draw back on the foot with the towel until first pain intervenes. Hold this position for 10 seconds. Relax the arms and the foot and rest for 10 seconds. Do this routine 10 times at least three times daily. Perform the same routine with the uninjured side to protect it from injury.

  • Double leg raises
    Stand erect with hands resting lightly on a chair back, table, or other supporting structure. Slowly raise up on the toes to the point of first pain at the injury site. Hold this position for 10 to 15 seconds, then return to start position. Rest for five seconds. Perform this sequence 10 times at least three times daily. This exercise both rehabilitates the injured tendon and helps protect the uninjured one.

  • Single leg raises
    Stand erect with one hand resting lightly on a supporting structure placed beside you. Flex the knee farthest from the supporting structure and raise the heel backward so that body weight is on the opposite leg. Slowly raise up on the toes of the weight-bearing leg. In the instance of the injured side, raise up only to the point of first pain. Hold this position for 10 to 15 seconds, then return to start position and rest for five seconds. Perform this cycle 10 times. Reverse the position of the legs and do the same sequence as described for the first exercised leg. Perform this series at least three times daily. This exercise both rehabilitates the injured tendon and helps protect the uninjured one.

    Attempt exercise 5 only after you can do exercise 4 through the full range of motion without significant pain. When you can do exercise 5 effortlessly and without pain, add resistance by holding a one- or two-pound weight in each hand. As strength builds, increase resistance in two- to three-pound increments for each hand.

    Alternative exercises
    During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:

  • swimming
  • water running
  • stationary bicycle (add resistance gradually from one session to the next, as pain allows).

    When can I return to my sport or activity?
    The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your Achilles tendon area recovers, not by how many days or weeks it has been since your injury occurred.

    You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:
  • You have full range of motion in the injured leg compared to the uninjured leg.
  • You have full strength of the injured leg compared to the uninjured leg.
  • You can jog straight ahead without pain or limping.
  • You can sprint straight ahead without pain or limping.
  • You can do 45-degree cuts, first at half-speed, then at full-speed.
  • You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.
  • You can do 90-degree cuts, first at half-speed, then at full-speed.
  • You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.
  • You can jump on both legs without pain and you can jump on the injured leg without pain.

    How long will the effects of the injury last?
    With proper rehabilitation, a first occurrence diagnosed and treated in its early stages usually lasts two weeks. If the injury has recurred several times, full recovery may take as long as six weeks.

    Frequent episodes of Achilles tendonitis may result in formation of calcium deposits in the tendon. Such a complication may require surgical treatment; full recovery under such circumstances can take months.


    • © - Seo Company & Online Marketing Agency - SynergizeIT
    Copyright - Orthopaedic Clinic Cape Town -