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Achilles Tendonitis
The Achilles tendon is the largest tendon in the human body. It is located at the back of the ankle joint and can be felt as a large, cord-like structure attaching to the back of the foot. Since tendons serve to attach muscles to bone, the Achilles tendon also attaches the large calf muscles, the gastrocnemius and soleus, to the back of the heel bone, the calcaneus. The muscle mass and strength of the gastrocnemius and soleus muscles are greater than all of the other muscles of the lower leg combined. Therefore, the pull of these muscles on the Achilles tendon is very large since these muscles help balance the body while standing, push the body forward during walking, spring the body forward during running, and spring the body upward during jumping. Because of the large amount of stress which the Achilles tendon is subjected to during running and jumping activities, the Achilles tendon is prone to injury. The most common form of injury to the Achilles tendon is called Achilles tendinitis, which is an inflammatory condition causing pain in the Achilles tendon. Achilles tendinitis generally occurs in people who are active in sports activities. Types of sports that commonly are associated with Achilles tendonitis are basketball, tennis, running, football, soccer, volleyball and other running and jumping sports. Achilles tendinitis tends to occur more frequently in older athletes than in younger athletes. As a person ages into their thirties and especially into their forties and fifties, the ligaments and tendons of the body tend to lose some of their stretchiness and are not as strong as before. This predisposes older indi?iduals who are active in running and jumping activities, to tendon injuries such as Achilles tendinitis. However, Achilles tendinitis can also occur in teenagers who are very active in running and jumping sports. Diagnosis Achilles tendinitis is diagnosed by a history and physical examination
of the patient who describes pain at the back of the ankle with walking
and/or running activities. The pain generally will be associated with
an increase in running or jumping intensity or frequency. It is also
often associated with a change from running in a thick heeled shoe
to a thin heeled shoe, such as going from training shoes to racing
flats and/or racing spikes in cross-country and/or track. The pain
from Achilles tendinitis is often so severe that running is impossible
and even walking is uncomfortable. Treatment Achilles tendinitis generally responds very well to conservative treatment as long as it is diagnosed and treated early. Surgery is rarely indicated unless the Achilles tendinitis is particularly severe and chronic, or if the tendon has ruptured completely. Initially, the podiatrist may treat the Achilles tendinitis by putting heel lifts into the patient’s shoes. In addition, the patient may be asked to av?id barefoot walking or walking in low-heeled shoes. Non-ster?idal anti-inflammatory drugs (NS?idS) such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Aleve) may also be prescribed to calm the inflammatory process in the tendon. Icing may be suggested to help decrease the inflammation and pain in the tendon. Stretching exercises for the calf muscles may also be given to the patient to help loosen the calf muscle and Achilles tendon so that the tendon is not under as much stress during normal daily walking activities. The stretching should not be done however if it causes pain in the Achilles tendon. Initially, the patient with Achilles tendinitis will be asked to
modify their activities to decrease their running and jumping activities
and do alternative physical activities, such as swimming, which don’t
put as much stress on the Achilles tendon. As the tendon starts to
feel better, the podiatrist will allow a gradual return to normal
running and jumping activities. If normal return to activities is
not possible within a few weeks, then many times the podiatrist may
additionally prescribe physical therapy and/or functional foot orthotics
to help the tendon heal more ra?idly. The foot orthotics generally
are used during both the sports activities and walking activities
to allow for more normal foot and Achilles tendon function. If the
physician is concerned about a partial tear of the tendon the patient
may be placed in a below the knee cast. It can take several weeks
or even months for the tendon to heal depending upon the severity
of the injury to the tendon. It is not uncommon for a patient to return
to activities too quickly and re-injure the tendon. Careful monitoring
of a return to full activity is important and the patient must have
patience during this period of time. This information is not intended to replace the advice of a doctor. American Health Network disclaims any liability for the decisions you make based on this information. |
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