Achilles Tendinitis is the inflammation of the Achilles Tendon located in the heel, and is typically caused by overuse of the affected limb. Most often, it occurs in athletes
who are not training with the proper techniques and/or equipment. When the Achilles Tendon is injured, blood vessels and nerve fibers from surrounding areas migrate into the tendon, and the nerve
fibers may be responsible for the discomfort. Healing is often slow in this area due to the comparably low amount of cellular activity and blood flowing through the area.
There are hundreds of tendons scattered throughout our body, but it tends to be a small handful of specific tendons that cause problems. These tendons usually have an area of poor blood supply that
leads to tissue damage and poor healing response. This area of a tendon that is prone to injury is called a "watershed zone," an area when the blood supply to the tendon is weakest. In these
watershed zones, they body has a hard time delivering oxygen and nutrients necessary for tendon healing, that's why we see common tendon problems in the same parts of the body. Tendonitis is most
often an overuse injury. Often people begin a new activity or exercise that causes the tendon to become irritated. Tendon problems are most common in the 40-60 year old age range. Tendons are not as
elastic and forgiving as in younger individuals, yet bodies are still exerting with the same force. Occasionally, there is an anatomical cause for tendonitis. If the tendon does not have a smooth
path to glide along, it will be more likely to become irritated and inflamed. In these unusual situations, surgical treatment may be necessary to realign the tendon.
Gradual onset of pain and stiffness over the tendon, which may improve with heat or walking and worsen with strenuous activity. Tenderness of the tendon on palpation. There may also be crepitus and
swelling. Pain on active movement of the ankle joint. Ultrasound or MRI may be necessary to differentiate tendonitis from a partial tendon rupture.
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.
There is insufficient evidence from randomised controlled trials to determine which method of treatment is the most appropriate for the treatment of acute or chronic Achilles tendonitis. The patient
should abstain from aggravating activities, but with a minimum of rest in order to preserve overall fitness. Possible treatments are non-steroidal anti-inflammatory drugs (NSAIDs), ice, rest,
increased warm-up/stretching exercises, physiotherapy and heel lifts (orthotic devices - used on both sides to prevent a gait imbalance). Other treatments evaluated in a Cochrane review were heparin,
steroid injections, glycosaminoglycan sulfate, Actovegin?, and topical laser treatment. There was no clear evidence of benefit from these. Casting is an option for resistant Achilles tendonitis.
Drugs - analgesics and NSAIDs. Surgery is sometimes used for resistant Achilles tendonitis, but usually as a last resort. Other recently reported treatments include continuing sporting activity in
conjunction with rehabilitation, low-energy shock wave therapy and topical glyceryl trinitrate .
As with any surgery there are risks to every procedure depending on a lot of factors, including your age, the severity of your injury and your level of health going into the procedure. It is always
best to discuss all possible risks and complications with your doctor, orthopaedic specialist and/or surgeon before the procedure. It's important to be aware of the risks you may face with any
procedure intended to fix or relieve pain from your Achilles tendon injury.
As with all injuries, prevention is your best defense especially with injuries that are as painful and inconvenient as Achilles tendonitis. Options for how to prevent Achilles tendonitis include,
stretching- Stretching properly, starting slowly, and increasing gradually will be critical if you want to avoid Achilles tendonitis. To help maintain flexibility in the ankle joint, begin each day
with a series of stretches and be certain to stretch prior to, and after, any exercise or excessive physical activity. Orthotics and Heel Support- Bio-mechanically engineered inserts and heel cups
can be placed in your shoes to correct misalignments or bolster the support of your foot and are available without a prescription. The temporary heel padding that these provide reduces the length
that the Achilles tendon stretches each time you step, making it more comfortable to go about your daily routine. Proper Footwear- Low-heeled shoes with good arch support and shock absorption are
best for the health of your foot. Look into heel wedges and other shoe inserts to make sure that your everyday foot mechanics are operating under ideal conditions.