Achilles Pain

Achilles Tendonitis

This is a painful condition which affects the achilles tendon. The achilles tendon connects the heel of the foot to the calve muscle. Achilles tendonitis causes pain during activity and also increases pain after activity. People who suffer from this condition will sometimes notice that the soles of shoes wear out quickly in the heel region.

Symptoms include:

• Discomfort or swelling in the back of your heel
• Tight calf muscles
• Limited range of motion when flexing your foot
• Skin on your heel overly warm to the touch

The Achilles tendon is a band of tissue that connects a muscle to a bone. It runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the heel cord, the Achilles tendon facilitates walking by helping to raise the heel off the ground.

Causes Of Achilles Pain
Achilles pain normally occurs from shearing, stretching forces placed on the achilles tendon.
Excessive activity or a sudden increase in activity can lead to achilles tendonitis.
Women who exercise by running are increasing the risk of developing achilles tendonitis, as studies have shown that women who wear high heeled shoes, effectively shorten the achilles tendon. Then when the individual takes up running in flat footwear, the achilles tendon is put under strain.
Over pronation can also lead to achilles tendonitits.
The biggest contributing factor is ignoring pain in the tendon.
 
Treatment of Achilles Pain
Reduce hill and speed running, reduce any ongoing training programme.
Avoid excessively flat shoes and avoid walking bare foot as much as possible.
High quality insoles with built in heel pads will help reduce the pressure on the achilles tendon.
Sports insoles are highly recommended to speed up recovery.
In very severe cases where the achilles tendon has ruptured, then surgery will be necessary.

RICE method

The rest, ice, compression, and elevation (RICE) method is usually effective in treating Achilles tendonitis right after you’re injured. This method works in the following way:

Rest: Don’t put pressure or weight on your tendon for one to two days until you can walk on the tendon without pain. The tendon usually heals faster if no additional strain is placed on it during this time. Your doctor may suggest that you use crutches if you need to go long distances while resting your tendon.

Ice: Put ice in a bag, wrap the bag in cloth, and place the wrapped bag of ice against your skin. Hold the bag on your tendon for 15 to 20 minutes, then take the bag off to let the tendon warm up again. The ice usually makes inflammation or swelling go down faster.

Compression: Wrap a bandage or athletic tape around your tendon to compress the injury. You can also tie an article of clothing around this area. This keeps the tendon from swelling too much. But don’t wrap or tie anything too tightly around your tendon, as it can limit blood flow.

Elevation: Raise your foot above the level of your chest. Because your foot is higher than your heart, blood returns to the heart and keeps the swelling down. This is easiest to do by lying down and putting your foot on a pillow or other raised surface.

The Achilles tendon is a band of tissue that connects a muscle to a bone. It runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the heel cord, the Achilles tendon facilitates walking by helping to raise the heel off the ground.

Two common disorders that occur in the heel cord are Achilles tendonitis and Achilles tendonosis.

Achilles tendonitis is an inflammation of the Achilles tendon. This inflammation is typically short-lived. Over time, if not resolved, the condition may progress to a degeneration of the tendon (Achilles tendonosis), in which the tendon loses its organized structure and is likely to develop microscopic tears. Sometimes the degeneration involves the site where the Achilles tendon attaches to the heel bone. In rare cases, chronic degeneration with or without pain may result in rupture of the tendon.

As "overuse" disorders, Achilles tendonitis and tendonosis are usually caused by a sudden increase of a repetitive activity involving the Achilles tendon. Such activity puts too much stress on the tendon too quickly, leading to micro-injury of the tendon fibers. Due to this ongoing stress on the tendon, the body is unable to repair the injured tissue. The structure of the tendon is then altered, resulting in continued pain.

Athletes are at high risk for developing disorders of the Achilles tendon. Achilles tendonitis and tendonosis are also common in individuals whose work puts stress on their ankles and feet, such as laborers, as well as in “weekend warriors”—those who are less conditioned and participate in athletics only on weekends or infrequently.

In addition, people with excessive pronation (flattening of the arch) have a tendency to develop Achilles tendonitis and tendonosis due to the greater demands placed on the tendon when walking. If these individuals wear shoes without adequate stability, their overpronation could further aggravate the Achilles tendon.

The symptoms associated with Achilles tendonitis and tendonosis include:

• Pain—aching, stiffness, soreness or tenderness—within the tendon. This may occur anywhere along the tendon’s path, beginning with the tendon’s attachment directly above the heel upward to the region just below the calf muscle. Pain often appears upon arising in the morning or after periods of rest, then improves somewhat with motion but later worsens with increased activity.
• Tenderness, or sometimes intense pain, when the sides of the tendon are squeezed. There is less tenderness, however, when pressing directly on the back of the tendon.
• When the disorder progresses to degeneration, the tendon may become enlarged and may develop nodules in the area where the tissue is damaged.
   

In diagnosing Achilles tendonitis or tendonosis, the surgeon will examine the patient’s foot and ankle and evaluate the range of motion and condition of the tendon. The extent of the condition can be further assessed with x-rays or other imaging modalities.

Treatment approaches for Achilles tendonitis or tendonosis are selected on the basis of how long the injury has been present and the degree of damage to the tendon. In the early stage, when there is sudden (acute) inflammation, one or more of the following options may be recommended:

• Immobilization. Immobilization may involve the use of a cast or removable walking boot to reduce forces through the Achilles tendon and promote healing.
• Ice. To reduce swelling due to inflammation, apply a bag of ice over a thin towel to the affected area for 20 minutes of each waking hour. Do not put ice directly against the skin.
• Oral medications. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be helpful in reducing the pain and inflammation in the early stage of the condition.
• Orthotics. For those with overpronation or gait abnormalities, custom orthotic devices may be prescribed.
• Night splints. Night splints help to maintain a stretch in the Achilles tendon during sleep.
• Physical therapy. Physical therapy may include strengthening exercises, soft-tissue massage/mobilization, gait and running re-education, stretching and ultrasound therapy.
   

If nonsurgical approaches fail to restore the tendon to its normal condition, surgery may be necessary. The foot and ankle surgeon will select the best procedure to repair the tendon, based on the extent of the injury, the patient’s age and activity level, and other factors.

To prevent Achilles tendonitis or tendonosis from recurring after surgical or nonsurgical treatment, the foot and ankle surgeon may recommend strengthening and stretching of the calf muscles through daily exercises. Wearing proper shoes for the foot type and activity is also important in preventing recurrence of the condition.