Is It Tendonitis or Tendinopathy...

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    Overview

    Achilles tendinitis may occur when overuse or to much strain is placed onto the tendon in the ankle region. The Achilles tendon is situated at the heel of the foot and connects the lower leg muscles of the calf to the heel bone of the ankle.

    This pathology is mainly sustained by people who do a lot of running and high intensity exercises. Individuals who may have amplified the time and intensity of their runs, thus potentially leading to Achilles tendinitis. This injury could also occur with a lot of people who play sports such as tennis, netball or basketball, due to the fast pace and explosive movements, causing added pressure onto the ankle joint. If not treated correctly Achilles tendinitis could lead to further complications such as tendon tears or ruptures, which may require surgical repair.

    Anatomy

    The Achilles tendon, also known as the calcaneal tendon is situated at the back of the ankle. It is a hard band of fibrous tissue that attaches the calf muscles to the calcaneus (heel bone of the ankle). The Achilles tendon is also the largest and strongest in the body.

    The two calf muscles; the gastrocnemius and soleus form into one band of tissue, which becomes the Achilles tendon at the lowest point of the calf. A bursa (small sac of fluid) covers the Achilles tendon to help support and protect the area.

    When we flex the calf muscles the Achilles tendon pulls onto the heel. This enables us to perform day to day movements such as walking, running and standing on our tip toes. So, it is important to be safe when exercising ensuring the area is protected. The tendon has a limited amount of blood supply, so when we place the tendon under strain or tension it can be more susceptible to injury.

    Causes

    The main causes for Achilles tendinitis are from repetitive stress and tension placed onto the tendon, it is not usually related to one specific injury cause. Too much pressure on our bodies sometimes can be harmful and extra care should be taken whenever performing any sporting event or exercise activities. Here are some causes of Achilles tendinitis:

    • Tightness in calf muscles
    • Sudden increase in intensity of exercise
    • Longer duration of exercise
    • Unexpected bone growth

    Symptoms

    Common signs and symptoms of Achilles tendinitis are as follows:

    • Stiffness at the back of the ankle first thing when you wake up
    • Pain along the back of the tendon
    • Sharp pain along the back of the foot
    • Feels different e.g., thicker or tighter
    • Lack of range of movement
    • Severe pain after exercising
    • Swelling around the tendon

    When exercising or walking and you feel or hear a loud popping noise, you should see your doctor immediately. As it is highly likely that you may have torn/ ruptured the tendon and will need medical attention.

    Diagnosis

    If you feel you are suffering with Achilles tendinitis, then it is best you go and see your doctor. The health care professional will palpate (feel) the area to determine the site of pain tenderness and swelling. The doctor will also complete a physical examination assessing flexibility, alignment, reflexes and range of movement around the effected area.

    Special imaging test may also be used such as:

    • X-Rays
    • Magnetic Resonance imagining (MRI)
    • Ultrasound

    Treatment

    Now days there are many treatment theories available for Achilles tendinitis. These could be home treatments, anti-inflammatory medication or surgery.

    • Use the RICE acronym- Rest, Ice, Compress and Elevate the area of injury
    • Reduce physical activity until swelling and pain has reduced
    • Ice the area after exercising when pain has occurred
    • Anti- inflammatory drugs such as aspirin or ibuprofen (however this may just mask the pain)
    • See a sports/ physiotherapist for rehabilitation exercises and stretches
    • Wear protective equipment such as a brace to prevent heel movement

    Exercises

    Here are a few exercises which may aid in preventing Achilles tendinitis:

    • Calf raises on floor
    • Single leg calf raises
    • Calf raises on elevated bench
    • Lunge calf stretch
    • Resistance band calf stretch
    • Resisted plantarflexion
    • Walking on tip toes

    Prevention

    It may not be possible to full prevent Achilles tendinitis from occurring, however you can incorporate certain measures to reduce the risk factors:

    • Don’t over do exercise, make sure to have rest days and include full warm ups before exercising
    • Increase intensity levels of exercise progressively
    • Make sure you are wearing the correct footwear
    • Stretch daily, and even more importantly before and after exercising
    • Perform specific exercises to strengthen the calf muscles
    • Complete non weight bearing exercise such as swimming to reduce pressure onto the Achilles tendon.

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