Overview
The Achilles tendon is the tendon that attaches the gastrocnemius (calf muscles) to the calcaneus bone (back of the heel). It is important in activities that involve plantar flexion of the ankle (pushing down with the foot or doing heel raises). The Achilles tendon can get inflamed (tendinitis) or it can degenerate/wear out (tendinopathy) with repetitive activities. Aggravating activities include running and/or repetitive jumping.
Causes
In some cases, Achilles Tendinitis can be caused by physical activity without a proper warm up or trauma, such as falling, to cause an overstressing of the muscle and tendon. Other causes include repetitive overuse syndrome, such as a job that required frequent heel lifting. Biomechanical causes such as pronation (or fallen arches) will cause the heel (calcaneus) to lean slightly, putting the undue stress on the Achilles tendon and the calf muscles. Most pain can be felt at the back of the heel or the point at which the calf muscle becomes a tendon three quarters of the distance down from the knee. Discomfort can be felt especially when jumping or when lifting the heel off the ground. Swelling and redness can often be seen at the back of the heel and touching the area would cause a tender sensation. In extreme cases, the tendon can become torn or rupture entirely which would cause bruising or an inability to put pressure on the foot.
Symptoms
Dull or sharp pain anywhere along the back of the tendon, but usually close to the heel. limited ankle flexibility redness or heat over the painful area a nodule (a lumpy build-up of scar tissue) that can be felt on the tendon a cracking sound (scar tissue rubbing against tendon) with ankle movement.
Diagnosis
A podiatrist can usually make the diagnosis by clinical history and physical examination alone. Pain with touching or stretching the tendon is typical. There may also be a visible swelling to the tendon. The patient frequently has difficulty plantarflexing (pushing down the ball of the foot and toes, like one would press on a gas pedal), particularly against resistance. In most cases X-rays don't show much, as they tend to show bone more than soft tissues. But X-rays may show associated degeneration of the heel bone that is common with Achilles Tendon problems. For example, heel spurs, calcification within the tendon, avulsion fractures, periostitis (a bruising of the outer covering of the bone) may all be seen on X-ray. In cases where we are uncertain as to the extent of the damage to the tendon, though, an MRI scan may be necessary, which images the soft tissues better than X-rays. When the tendon is simply inflamed and not severely damaged, the problem may or may not be visible on MRI. It depends upon the severity of the condition.
Nonsurgical Treatment
Many physical therapies exist to help with the pain. We have found the combination of modalities, stretching, acupuncture, footwear modification and myofascial release to be very effective. In resilient cases, a promising new treatment called Radial Shockwave may be indicated. The key to the treatment of this, and other foot problems, is an accurate diagnosis. With this, a treatment regimen tailored to you and your specific situation can be devised. We treat many acute and chronic achilles tendinitis in Edmonton and St. Albert, so remember ?it shouldn?t hurt.?
Surgical Treatment
Surgery for an Achilles tendon rupture can be done with a single large incision, which is called open surgery. Or it can be done with several small incisions. This is called percutaneous surgery. The differences in age and activity levels of people who get surgery can make it hard to know if Achilles tendon surgery is effective. The success of your surgery can depend on, your surgeon's experience. The type of surgery you have. How damaged the tendon is. How soon after rupture the surgery is done. How soon you start your rehab program after surgery. How well you follow your rehab program. Talk to your surgeon about his or her surgical experience. Ask about his or her success rate with the technique that would best treat your condition.
Prevention
To prevent Achilles tendonitis or tendonosis from recurring after surgical or non-surgical treatment, the foot and ankle surgeon may recommend strengthening and stretching of the calf muscles through daily exercises. Wearing proper shoes for the foot type and activity is also important in preventing recurrence of the condition.
The Achilles tendon is the tendon that attaches the gastrocnemius (calf muscles) to the calcaneus bone (back of the heel). It is important in activities that involve plantar flexion of the ankle (pushing down with the foot or doing heel raises). The Achilles tendon can get inflamed (tendinitis) or it can degenerate/wear out (tendinopathy) with repetitive activities. Aggravating activities include running and/or repetitive jumping.
Causes
In some cases, Achilles Tendinitis can be caused by physical activity without a proper warm up or trauma, such as falling, to cause an overstressing of the muscle and tendon. Other causes include repetitive overuse syndrome, such as a job that required frequent heel lifting. Biomechanical causes such as pronation (or fallen arches) will cause the heel (calcaneus) to lean slightly, putting the undue stress on the Achilles tendon and the calf muscles. Most pain can be felt at the back of the heel or the point at which the calf muscle becomes a tendon three quarters of the distance down from the knee. Discomfort can be felt especially when jumping or when lifting the heel off the ground. Swelling and redness can often be seen at the back of the heel and touching the area would cause a tender sensation. In extreme cases, the tendon can become torn or rupture entirely which would cause bruising or an inability to put pressure on the foot.
Symptoms
Dull or sharp pain anywhere along the back of the tendon, but usually close to the heel. limited ankle flexibility redness or heat over the painful area a nodule (a lumpy build-up of scar tissue) that can be felt on the tendon a cracking sound (scar tissue rubbing against tendon) with ankle movement.
Diagnosis
A podiatrist can usually make the diagnosis by clinical history and physical examination alone. Pain with touching or stretching the tendon is typical. There may also be a visible swelling to the tendon. The patient frequently has difficulty plantarflexing (pushing down the ball of the foot and toes, like one would press on a gas pedal), particularly against resistance. In most cases X-rays don't show much, as they tend to show bone more than soft tissues. But X-rays may show associated degeneration of the heel bone that is common with Achilles Tendon problems. For example, heel spurs, calcification within the tendon, avulsion fractures, periostitis (a bruising of the outer covering of the bone) may all be seen on X-ray. In cases where we are uncertain as to the extent of the damage to the tendon, though, an MRI scan may be necessary, which images the soft tissues better than X-rays. When the tendon is simply inflamed and not severely damaged, the problem may or may not be visible on MRI. It depends upon the severity of the condition.
Nonsurgical Treatment
Many physical therapies exist to help with the pain. We have found the combination of modalities, stretching, acupuncture, footwear modification and myofascial release to be very effective. In resilient cases, a promising new treatment called Radial Shockwave may be indicated. The key to the treatment of this, and other foot problems, is an accurate diagnosis. With this, a treatment regimen tailored to you and your specific situation can be devised. We treat many acute and chronic achilles tendinitis in Edmonton and St. Albert, so remember ?it shouldn?t hurt.?
Surgical Treatment
Surgery for an Achilles tendon rupture can be done with a single large incision, which is called open surgery. Or it can be done with several small incisions. This is called percutaneous surgery. The differences in age and activity levels of people who get surgery can make it hard to know if Achilles tendon surgery is effective. The success of your surgery can depend on, your surgeon's experience. The type of surgery you have. How damaged the tendon is. How soon after rupture the surgery is done. How soon you start your rehab program after surgery. How well you follow your rehab program. Talk to your surgeon about his or her surgical experience. Ask about his or her success rate with the technique that would best treat your condition.
Prevention
To prevent Achilles tendonitis or tendonosis from recurring after surgical or non-surgical treatment, the foot and ankle surgeon may recommend strengthening and stretching of the calf muscles through daily exercises. Wearing proper shoes for the foot type and activity is also important in preventing recurrence of the condition.
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