ACHILLES TENDONITIS | SOUTH TEXAS FOOT SPECIALIST
Achilles was a great warrior in Greek Mythology. The legend was that Achilles has armor that made him invulnerable except for his heel. He was killed by an arrow in the back of his heel at the end of the Trojan war. The issue is one of both strength and vulnerability.
The Achilles tendon is the both the strongest and largest tendon in the human body and can withstand tensile (pulling) forces of 1,000 pounds or more. It also is the most frequently injured tendon. Achilles tendon ruptures occur at a higher rate than any other tendon ruptures, often during athletic activity.
There are two categories of Achilles ruptures, acute traumatic and pathologic. A sudden upward force, forcing the foot upward on the ankle suddenly can lead to a rupture. The tendon can also undergo degeneration and become weak with aging and tear with forces that are not great. What do we mean by aging? Ruptures due to degeneration may occur to non-athletes 50 years of age and older but such ruptures have been seen in NBA pros as young as 37. Degeneration can occur from a combination of factors such as decreased blood flow to parts of the tendon, chronic repetitive strain due to excessive tightness of the tendon or torsional strain. Imaging such as ultrasound and MRI can detect weak Achilles tendons.
Achilles tendinitis can effect sedentary individuals, professional athletes and weekend warriors. It involves painful inflammation of the tendon.
Dr. Ed Davis, San Antonio Podiatrist, was an early adopter of high-resolution diagnostic ultrasound used for early diagnosis of Achilles tendon issues and has a large armamentarium of treatments for this problem.
Events that can cause Achilles tendonitis may include:
- Running on hills/inclines or stair climbing.
- Overuse or chronic repetitive strain ,resulting from the lack of flexibility in the calf muscles.
- Training mistakes such as too rapidly increasing mileage or speed when walking, jogging, or running.
- Starting up too quickly after an injury, a hiatus in exercise or sports activity, without proper strengthening or conditioning of the calf muscles.
- Acute trauma due to a sudden and/or hard contraction of the Achilles and calf muscles when putting out extra effort,such as in a sprint.
- Improper footwear and/or a tendency toward torsional instability caused by oversupination (rolling out) or overpronation (rolling in). The foot acts as a first class lever on the ankle when pushing off and a lever requires a degree of rigidity. Shoes with flaccid shanks cause the Achilles tendon to work harder.
Achilles tendonitis frequently starts with mild pain after exercise that gradually worsens.
Other symptoms include:
- Recurring pain and/or swelling, sometimes severe, in the tendon during or a few hours after exercise.
- Morning tenderness or tenderness upon arising about an inch and a half above the point where the
- Achilles tendon is attached to the heel bone.
- A feeling of weakness in your leg.
- Mild or severe swelling.
- Stiffness that typically reduces as the tendon warms up with use.
Treatment normally includes:
- A taping or splint specifically designed to restrict motion of the tendon.
- Using NSAIDS (non-steroidal anti-inflammatory drugs) for a short period of time. Note: Please consult your physician before taking any medication.
- Orthotics, which are corrective shoe inserts created to help support the foot/ankle and relieve stress on the tendon. Both OTC/nonprescription orthoses (such as a heel pads or over-the-counter shoe inserts) and prescription custom orthotics may be recommended depending on the length and severity of the problem. Prescription orthoses are available at Dr. Ed Davis podiatrist office in San Antonio.
- Controlled rest and switching to exercises that do not stress the tendon (such as swimming).
- Eccentric stretching exercises to strengthen the relatively weak muscle group in front of the leg, calf, and the upward foot flexors coupled with manual therapy to increase the length of the calf muscles. Deep tissue as massage and ultrasound may be utilized.
In extreme cases, surgery is performed to remove the fibrous tissue and repair any tears although minimally invasive treatments such as ESWT and the Topaz procedure have supplanted many such surgical treatments.