Achilles Tendinitis

Anatomy Risk Factors
Symptoms Rehab Program
Treatment Outcomes
Prevention Similar Injuries
synonyms: achilles tendinosis, achilles tendinitis, achilles tendonitis, heel pain, ankle pain

Achilles Tendinitis Description
Achilles Tendonitis is a common overuse syndrome causing pain in the heel or back of the ankle.  It occurs mainly in athletes, although anyone can be affected.  Achilles tendinitis most commonly affects long distance runners. Achilles tendinitis also occurs frequently  in dancers, basketball players and tennis.

Achilles tendinitis is associated with overtraining, functional over pronation, and gastrocnemius and soleus muscle weakness.  Patients with Achilles tendonitis ofter overuse the Achilles tendon and have a history of tight calf muscles.  Runners with Achilles tendonitis may have increased their uphill running, or increased the amount or intensity of sports training or recently switch there shoes (running flats or over-pronation shoes).  Over-pronation (the feet roll inward and flatten out more than normal)  is often involved.

Achilles Tendinitis Anatomy
Achilles tendonThe Achilles tendon is formed by the confluence of the Gastrocnemius and Soleus muscles approximately 15cm above the calcaneous (heel bone).  There is a hypovascular zone in the Achilles tendon 3-6cm proximal to its calcaneal insertion which may be involved in tendinosis or Achilles tendon rupture.  The tensile forces in the Achilles tendon are very high.  These forces have been shown to be 1,400 to 2,600 N with walking and 3,100 to 5,330 N during running. This is more commonly noted as 6-8 times body weight.

Achilles Tendinitis Symptoms
Achilles tendonitis causes pain and swelling in the Achilles tendon.  Generally there is no history of an injury. Achilles tendonitis symptoms are often associated with an increase in training intensity, interval training, change from soft surface to hard surface training, or worn-out footwear.

Achilles Tendinitis Treatment
Achilles tendonitis is diagnosed based on a detailed history, physical exam and xrays performed by an orthopaedic surgeon, or sports medicine specialist.   There are generally consider to be three stages in Achilles tendonitis begining with simple peritendinous inflammation with pain after prolonged running and finishing with visible disruptions in the tendon and an inability to run at all. 

Initial treatment for Achilles tendonitis is centered around icing, activity modification, eccentric calf stretching and physical therapy with eccentric strengthening, plyometrics and a gradual activity return. Heel lifts (1/4-3/8in), NSAIDs, walking boots, orthotics to correct excessive pronation,  and ultrasound are also considered for treatment.  When nonsurgical treatment fails to provide long term improvement surgery is considered. 

Recovery from Achilles tendonitis can take weeks to months.  Unfortunately the avid runner frequent does not seek treatment soon enough or returns to running too soon causing re-injury and delaying recovery.  The longer a person has symptoms before starting treatment, the longer it takes to recover. 

Athletes returning to sports after Achilles tendonitis should begin with a graduated exercise program.  First they should be pain free with daily activities with full range of motion and at least 85% strength in the injured leg compared to the uninjured leg.  Exercise begins with light jogging in a  straight line, followed by sprinting in a straight line.  When these have been done without pain the athlete can proceed to doing agility type drills such as 45º cuts, 90º cuts and jumping.  Agility drills should begin at half-speed and proceed to full-speed provided the athlete remains pain free.

Achilles Tendinitis Prevention
Prevention of Achilles tendonitis and Achilles tendon injury is stretching the calf muscles before and after exercise.  Athletes recovering from Achilles tendonitis must warm up and stretch the Achilles tendon before running, apply ice for 10 minutes after running, and maintain proper shoes to prevent recurrence.

Achilles Tendinitis Risk Factors
Achilles tendinitis is associated the following sports:  Baseball; Basketball; Boxing; Cycling; Dance; Diving; Equestrian Sports; Figure Skating; Football; Golf; Gymnastics; Hockey; Rowing; Rugby; Running; Skiing; Snowboarding; Soccer; Swimming; Tennis; Volleyball; Weight Lifting; Wrestling. andTypically these are sports that require repetitive or extreme calf muscle forces.  It is more common in athletes who are poorly conditioned and do not adequately warm-up prior to their sporting activities.  

Achilles Tendinitis Rehab and Exercise Program

Achilles Tendinitis Outomes

Similar injuries that can be confused with Achilles Tendonitis include:

Haglund's Deformity
Retrocalcaneal bursitis
Insertional Achilles Tendonitis
Calcaneal Stress fracture
Chronic Exertional Compartment Syndrome

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