Achilles tendinitis

 achilles tendinitisAchilles tendinitis

Description, Causes and Risk Factors:

ICD-10: M76.6

Abbreviation: AT.

The Achilles tendon is a strong tendon that connects the calf muscles to the heel. When the calf muscles contract they pull on the Achilles tendon causing your foot to point down (plantar flexor) allowing you rise up on your toes. This powerful muscle group allowing you to sprint, jump, or climb.

Achilles tendonitis is an inflammation of the tendon (a cord or band of inelastic tissue connecting a muscle with its bony attachment) that connects your calf muscles (gastrocnemius and soleus) to the back of the heel (calcaneus). Pain typically occurs about two centimeters above the site of insertion into the heel.

Grades:

Grade 1 - Pain does not occur during activity, but generalized pain will be felt in the Achilles region after the training session has ended. Tenderness in the Achilles tendon will resolve before the next training session.

  • Grade 2 - Minimal localized pain will be present in the Achilles tendon during the training session; the pain will disappear before the next training session.
  • Grade 3 - Pain in the Achilles tendon now interferes with the training session but disappears before the next training session.
  • Grade 4 - Pain in the Achilles tendon severely interferes with the training sessions and does not disappear before the next training session.
  • Grade 5 - Pain in the Achilles tendon interferes with the training sessions and activities of daily living. The Achilles tendon becomes deformed and there is a loss of function of the triceps surae.

With aging and overuse, the Achilles tendinitis is subject to degeneration or weakening within the substance of the tendon. Over time, some of the individual strands of the tendon can fray, other fibers break, and the tendon begin to lose strength. The body tries to heal the tendon, so the tendon becomes thickened because of the formation of scar tissue. The process can result in the formation of tendon nodule within the tendon. This process can result in the formation of tender nodule within the tendon. This condition called tendinitis or tendinosis.

Achilles tendinitis rupture can occur when suddenly jumping or pushing off forcefully such as in tennis, squash, racquetball, and basketball. Rupture is more common in men than woman in their third to fifth decade.

When the Achilles tendinitis ruptures, the person often hears a "pop" at the back of the lower leg. There is sudden pain in the region of the Achilles tendon that subsides quickly. Rupture of the tendon causes weakness when trying to stand on tiptoes. A defect or gap in the Achilles tendon can usually be felt. The torn tendon usually has to be repaired surgically. An alternative treatment is prolonged cast immobilization.

Anyone can get Achilles tendinitis, but it is most common in young to middle-aged males, particularly those participating in athletics and other sporting activities. It is most likely to develop in people who have taken up unaccustomed running, long walks or other exercise. It is often seen in people who have competed in a long or rigorous sporting event and also in runners who have changed their routine.

Symptoms:

Symptoms may include:

Pain in and around the heel and ankle.

  • Pain worse on rising in the morning.
  • Pain worse on starting activity and forsome time after ceasing it.
  • A deep ache on using the calf muscles.
  • Stiffness in the tendon.
  • Tenderness of the tendon.
  • A clicking or similar noise on moving thetendon.
  • Swelling of the heel and ankle.
Related: Restless Leg Syndrome

Diagnosis:

The doctor will perform a physical exam and look for tenderness along the tendon and for pain in the area of the tendon when you stand on your toes.Imaging studies can also be helpful. X-rays can help diagnose arthritis, and an MRI will show inflammation in the tendon.

Treatment:

Treatment has two objectives to reduce the inflammation and to allow the tendon to heal. When the Achilles tendon is painful and swollen, you must rest it. Avoid running and jumping sports. You can use a heel lift in your shoe to help relieve strain on the Achilles tendon. Let pain be your guide. You are aggravating the condition if you continue activities while experiencing pain. Mild discomfort or ache is not a problem but definite pain is a cause for concern.

General Treatment Options May Include:

Rest is important: It is advisable to use crutches if the pain is severe, and a plaster cast is sometimes applied for very severe cases.

  • Use comfortable, high-heeled shoes for both feet. It may be better to use a 2 cm heel raise. A raised heel reduces the tension in the tendon.
  • Cool the tendon with icepacks when it is painful and swollen. When the swelling settles, use heat packs.
  • Apply a firm, stretch elastic bandage around the ankle or an elastic ankle support to achieve some degree of immobilization and support.
  • Use analgesics (pain-killers), preferably paracetamol, if there is significant discomfort.
  • Use NSAIDs for at least 2-3 weeks during the initial acute phase.
  • Gently massage the tendon by holding it firmly between the fingers and moving it from side to side.
  • Do stretching exercises. This includes stretching the calf muscles with the heel firmly on the ground. Another method is to lie on your back, lift the affected leg straight up, place a cord or wide ribbon around the base of the toes and flex the foot repeatedly by pulling the cord towards you.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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