Achilles tendonitis is
an iInflammation in the tendon of the calf muscle, where it attaches to the heel bone. Achilles tendonitis causes pain and stiffness at the back of the leg, near the heel. Achilles tendonitis can be
caused by overuse of the Achilles tendon, overly tight calf muscles or Achilles tendons, excess uphill running, a sudden increase in the intensity of training or the type of shoes worn to run, or
wearing high heels at work and then switching to a lower-heeled workout shoe. Achilles tendonitis causes pain, tenderness, and often swelling over the Achilles tendon. There is pain on rising up on
the toes and pain with stretching of the tendon. The range of motion of the ankle may be limited. Treatment includes applying ice packs to the Achilles tendon, raising the lower leg, and taking an
anti-inflammatory medication. In some severe cases of Achilles tendonitis, a cast may be needed for several weeks. A heel lift insert may also be used in shoes to prevent future overstretching of the
Achilles tendon. Exerting rapid stress on the Achilles tendon when it is inflamed can result in rupture of the tendon.
When you place a large amount of stress on your Achilles tendon too quickly, it can become inflamed from tiny tears that occur during the activity. Achilles tendonitis is often a result of
overtraining, or doing too much too soon. Excessive hill running can contribute to it. Flattening of the arch of your foot can place you at increased risk of developing Achilles tendonitis because of
the extra stress placed on your Achilles tendon when walking or running.
Paratenonitis presents in younger people. Symptoms start gradually and spontaneously. Aching and burning pain is noted especially with morning activity. It may improve slightly with initial activity,
but becomes worse with further activity. It is aggravated by exercise. Over time less exercise is required to cause the pain. The Achilles tendon is often enlarged, warm and tender approximately 1 to
4 inches above its heel insertion. Sometimes friction is noted with gentle palpation of the tendon during ankle motion. Tendinosis presents similarly but typically in middle-aged people. If severe
pain and limited walking ability are present, it may indicate a partial tear of the tendon.
Confirming Achilles tendonitis may involve imaging tests. X-rays provide images of the bones of the foot and leg. Magnetic resonance imaging (MRI) is useful for detecting ruptures and degeneration of
tissue. Ultrasound shows tendon movement, related damage, and inflammation.
Self-care strategies include the following steps, often known by the acronym R.I.C.E, Rest. You may need to avoid exercise for several days or switch to an activity that doesn't strain the Achilles
tendon, such as swimming. In severe cases, you may need to wear a walking boot and use crutches. Ice. To decrease pain or swelling, apply an ice pack to the tendon for about 15 minutes after
exercising or when you experience pain. Compression. Wraps or compressive elastic bandages can help reduce swelling and reduce movement of the tendon. Elevation. Raise the affected foot above the
level of your heart to reduce swelling. Sleep with your affected foot elevated at night.
Following the MRI or ultrasound scan of the Achilles tendon the extent of the degenerative change would have been defined. The two main types of operation for Achilles tendinosis are either a
stripping of the outer sheath (paratenon) and longitudinal incisions into the tendon (known as a debridement) or a major excision of large portions of the tendon, the defects thus created then being
reconstructed using either allograft (donor tendon, such as Wright medical graft jacket) or more commonly using a flexor hallucis longus tendon transfer. In cases of Achilles tendonosis with more
minor degrees of degenerative change the areas can be stimulated to repair itself by incising the tendon, in the line of the fibres, which stimulates an ingrowth of blood vessels and results in the
healing response. With severe Achilles tendonosis, occasionally a large area of painful tendon needs to be excised which then produces a defect which requires filling. This is best done by
transferring the flexor hallucis longus muscle belly and tendon, which lies adjacent to the Achilles tendon. This results in a composite/double tendon after the operation, with little deficit from
the transferred tendon.
There are several things you can do to reduce the risk of Achilles tendinitis, warm up every time before you exercise or play a sport. Switch up your exercises. Slowly increase the length and
intensity of your workouts. Keep your muscles active and stay in shape all year-round. When you see symptoms of Achilles tendinitis, stop whatever activity you are doing and rest.