The Achilles tendon is the large sinew located at the back of the ankle. It connects the calf muscles to the heel bone and is responsible for providing power during the “push off” phase of the gait cycle or the complex activity of walking.
When the Achilles tendon is injured because of overuse, the resulting condition is known as Achilles tendonitis. Some sports injury experts say that Achilles tendonitis is now called Achilles tendinopathy since it is no longer considered to be an inflammatory condition.
Achilles tendonitis accounts for over 10 percent of all running injuries. It can either be acute or chronic.
Acute Achilles tendonitis lasts for a few days. It is characterized by:
- Slow onset of pain at the back of the ankle
- Pain that develops over a few days
- Pain that is alleviated by treatment and rest.
- Tender feeling in the injured area during palpation
If left untreated or if not allowed enough rest, acute Achilles tendonitis could worsen and progress to chronic Achilles tendonitis.
Chronic Achilles tendonitis is characterized by recurring pain that lasts for longer periods of time. Chronic Achilles tendonitis is further characterized by:
- Slow onset of pain over a period of several weeks or months
- Constant pain throughout an exercise
- Pain and stiffness in the tendon particularly after rest or waking up in the morning.
- Presence of lumps or nodules in the Achilles tendon
- Swelling or thickening over the Achilles tendon
- Redness of the skin over the injured area
- A creaking feeling when you try to move your ankle or when you press your fingers into the tendon.
Chronic tendonitis is hard to treat, especially in older individuals.
Causes of Achilles Tendonitis
Achilles tendonitis as said earlier is an injury to the Achilles tendon that is caused by overuse. A person who is trying to achieve bodybuilding fat loss and is new to exercise can injure his Achilles tendon if he tries to do too much too soon. Achilles tendonitis can also affect seasoned athletes and runners. When a person suddenly increases his speed or extends his running session, he puts himself at risk of injuring his Achilles tendon.
There are other causes of this condition. These include:
- Insufficient recovery time in between activities.
- Sudden change of training surface or footwear.
- Reduced range of motion at the ankle joint. This is often caused by tight calf muscles.
- Weak calf muscles
- Running uphill or at inclined plane. The upward movement causes the Achilles tendon to stretch more than usual with each stride, causing it to get tired sooner.
- Feet that rolls in when you run can put additional strain in the Achilles tendon. This rolling in of the feet is called overpronation. As your foot rolls in, the lower leg also turns inwards, putting twisting strains on the tendon.
- Constantly wearing high heels shortens the tendon and calf muscles. When you suddenly switch to flat shoes or start running in flat rubber shoes, the Achilles tendon is stretched more than usual, and is put under an abnormal strain.
Achilles Tendonitis Risk Factors
While Achilles tendonitis is usually caused by severe or repetitive strain on the Achilles tendon, several factors may increase your risk of developing this condition. Here are some of them:
- Physical Problems – having tight calf muscles can add to the strain placed on the tendons. The same thing goes for obesity. Also, being naturally flat footed (having a flat arch in the foot) can increase strain on the tendons.
- Medical Problems – certain conditions such as high blood pressure or diabetes can increase your risk of developing Achilles tendonitis.
- Factors involved in training – pain in the tendon happens more often in cold weather than in warm weather. Also, wearing worn training shoes increases your risk of having Achilles tendonitis.
- Age and gender – it has been found that Achilles tendonitis is most common among middle-aged men.
Diagnosing Achilles Tendonitis
Your doctor will perform a physical exam which involves gently pressing on the injured area to determine the precise location of the pain and swelling. He or she will also check the alignment, flexibility, reflexes and range of motion of your foot and ankle.
Your doctor will also order imaging tests to determine the extent of your injury. These tests may include
- X-rays – X-rays can help your doctor rule out other conditions even though they can’t visualize soft tissues.
- Magnetic resonance imaging (MRI) – Magnetic resonance imaging or MRI uses radio waves and a powerful magnet to produce a detailed image of your Achilles tendon.
- Ultrasound – ultrasounds use sound waves to create images of soft tissues including your Achilles tendon. An ultrasound can also create real-time images of your Achilles tendon while in motion.
Treating Achilles Tendonitis
The treatment of Achilles tendonitis involves plenty of rest and medication. It is crucial for a person with Achilles tendonitis to get enough rest and rehabilitate the tendon and let it heal properly. Otherwise, the injury will come back and could become worse.
Anti-inflammatory medications may be prescribed by your doctor to alleviate the pain. Treatment may also include:
- Cold treatment or applying a cold compress to the injured area.
- Wearing a heel pad to elevate the heel and remove some of the strain on the tendon.
- Applying a plaster gauze in case of a severe injury.
- Various sports massage techniques
- A steroid injection, though not all therapists and specialists prescribe this form of treatment.
- Stretching and strengthening exercises to encourage the healing and strengthening of the tendon.
- Surgery for a torn Achilles tendon. Surgery may also be performed if the condition does not improve after several months of treatment.
- Other treatment procedures include ultrasound treatment and Extracorporeal Shock Wave Therapy (ESWT).