What Can Cause Achilles Tendonitis

Overview
A tendon is a tough yet flexible band of fibrous tissue. The tendon is the structure in your body that connects your muscles to the bones. The skeletal muscles in your body are responsible for moving your bones, thus enabling you to walk, jump, lift, and move in many ways. When a muscle contracts it pulls on a bone to cause movements. The structure that transmits the force of the muscle contraction to the bone is called a tendon. Tendons come in many shapes and sizes. Some are very small, like the ones that cause movements of your fingers, and some are much larger, such as your Achilles tendon in your heel. When functioning normally, these tendons glide easily and smoothly as the muscle contracts. Sometimes the tendons become inflamed for a variety of reasons, and the action of pulling the muscle becomes irritating. If the normal smooth gliding motion of your tendon is impaired, the tendon will become inflamed and movement will become painful. This is called tendonitis, and literally means inflammation of the tendon.

Causes
Achilles tendonitis occurs in sports such as running, jumping, dancing and tennis. Other risk factors include participation in a new sporting activity or increasing the intensity of participation. Poor running technique, excessive pronation of the foot and poorly fitting footwear may contribute. In cyclists, the problem may be a low saddle, which causes extra dorsiflexion of the ankle when pedalling. Quinolone antibiotics (eg, ciprofloxacin, ofloxacin) can cause inflammation of tendons and predispose them to rupture.

Symptoms
Recurring localized pain, sometimes severe, along the tendon during or a few hours after running. Morning tenderness about an inch and a half above the point where the Achilles tendon is attached to the heel bone. Sluggishness in your leg. Mild or severe swelling. Stiffness that generally diminishes as the tendon warms up with use.

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
NSAIDs help decrease swelling and pain or fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions. Steroid injections. Steroids decrease pain and swelling. After you get this shot, you may feel like your Achilles tendon is healed. Do not return to your regular exercise until your caregiver says it is okay. You could make the tendinitis worse, or even tear the tendon. Surgery. If your tendinitis does not heal with other treatments, you may need surgery. Surgery may be done to repair a tear in the tendon, or to remove parts of the tendon. The most important way to manage Achilles tendinitis is to rest. Rest decreases swelling and keeps your tendinitis from getting worse. You may feel pain when you begin to run or exercise. The pain usually goes away as your muscles warm up, but it may come back. Your caregiver may tell you to stop your usual training or exercise activities. He may give you other exercises to do until your Achilles tendon heals. Ice decreases swelling and pain. Put ice in a plastic bag. Cover it with a towel. Put this on your Achilles tendon for 15 to 20 minutes, 3 to 4 times each day. Do this for 2 to 3 days or until the pain goes away. After 2 or 3 days, you may use heat to decrease pain and stiffness. Use a hot water bottle, heating pad, whirlpool, or warm compress. To make a compress, soak a clean washcloth in warm water. Wring out the extra water and put it on your Achilles tendon 15 to 20 minutes, 3 to 4 times each day. Stretching and making the muscles stronger may help decrease stress on your Achilles tendon. Physical therapists can teach you exercises and treatments to help your tendinitis heal faster. You may need to wear inserts in your shoes. You may need to wrap tape around your heel and back of the leg. You may need to wear a cast, brace, or support boot.



Surgical Treatment
Occasionally, conservative management of Achilles tendon conditions fails. This failure is more common in older male patients and those with longstanding symptoms, those who persist in full training despite symptoms or those who have uncorrected predisposing factors. In these cases, surgery may be indicated. It should be remembered, however, that the rehabilitation program, particularly for severe Achilles tendon injuries, is a slow, lengthy program. Surgery is only indicated when there is failure to progress in the rehabilitation program. Surgery should not be considered unless at least six months of appropriate conservative management has failed to lead to improvement.

Prevention
Warm up slowly by running at least one minute per mile slower than your usual pace for the first mile. Running backwards during your first mile is also a very effective way to warm up the Achilles, because doing so produces a gentle eccentric load that acts to strengthen the tendon. Runners should also avoid making sudden changes in mileage, and they should be particularly careful when wearing racing flats, as these shoes produce very rapid rates of pronation that increase the risk of Achilles tendon injury. If you have a tendency to be stiff, spend extra time stretching. If you?re overly flexible, perform eccentric load exercises preventively. Lastly, it is always important to control biomechanical alignment issues, either with proper running shoes and if necessary, stock or custom orthotics.