Achilles Tendonitis - A Painful Foot Condition

Achilles Tendonitis is a debilitating foot condition characterized by swelling of the Achilles tendon – the largest and strongest tendon in the body – more commonly know as the ‘heel cord.’ Athletes are especially prone to chronic Achilles Tendonitis. In fact, around 18% of serious runners experience it in their life.

If it is not treated properly, a simple Achilles Tendon injury can progress into Acute Achilles Tendonitis and make walking impossible. Podiatrists recommend that the condition be treated as early as possible.

 

What are the symptoms of achilles tendonitis?

Achilles Tendinitis does not happen overnight, and usually does not manifest itself right away. Pain is usually mild at first, but it worsens with continued activity.

The first stage of the achilles tendon injury, called Peritenonitis, has no visible symptoms. The patient may feel pain during activity or while at rest, but will not see any physical manifestation of damage.

As achilles tendon injury progresses to the second stage (called Tendinosis), the patient may begin to notice some swelling or hard knots of tissue on the back of the leg.

If the feet are subjected to more physical activity and strain, the tendon may partially or completely rupture. This is the third stage (referred to as Peritenonitis with Tendinosis). The result is traumatic damage to the tendons – a condition that can impair the legs from walking and require extended recovery period.

 

What causes achilles tendonitis?

Although achilles tendonotis is more common in poorly-conditioned athletes, non-athletes can also develop the condition because of everyday stress on the feet and other factors.

High-impact activities

If you regularly perform activities that require sudden stops or repetitive movements (such as dancing, basketball, jogging, etc.), you increase your risk of incurring achilles tendon injury. Abrupt changes in the intensity of the activity and unsuitable footwear all increase the injury’s likelihood of developing.

Congenital conditions

Some people are born more prone to achilles tendinitis. Their foot and legs rotate abnormally, causing the arch of their feet to flatten and their legs to twist more than normal legs do. The gastrocnemius and soleus (lower leg muscles) stretch and tighten too much, increasing the stress on the Achilles tendon and ultimately causing achilles tendonitis.

Shoes

Sudden changes in footwear may also cause achilles tendonitis. When the feet are always high heels, for example, the Achilles tendon adapts overtime to a shortened position because the heeled shoes keep the heel bone from stretching all the way to the ground. When the feet suddenly wear flats, achilles tendons are forced to stretch more. This unfamiliar stretch can cause inflammation.

 

How to diagnose achilles tenodonitis?

After studying a patient’s history and routine physical examination (including palpating the lower lags for atrophy and measurement of passive ranges of motion of the feet, ankles and knees), one or a both of the following tests is usually conducted:

Thompson Test

This test detects the rupture of the achilles tendon. The patient is required to lay face downward and bend his knees as the doctor presses on the back side of the calves. The foot flexes if the achilles tendon is at least partly undamaged.
Imaging Test

Imaging Test

Some patients may be required to undergo X-Ray, MRI Scans, and Ultrasound (or a combination). The x-ray helps detect swelling and fractures, the MRI detects any partial rupture or degenerative manifestations in the tendons, and ultrasound detects the Achilles tendon’s thickness.

 

What treatment options are available for achilles tendonitis?

A patient suffering from achilles tendonitis will be asked to discontinue the activity that caused the condition until the tendons recover. Most are also required to put ice on the area (usually for 20 minutes every hour for one to two days to reduce swelling), elevate the feet whenever possible, and compress the area with elastic bandage.

If this does not solve the problem, doctors may ask the patient to undergo basic rehabilitation and perform stretching and training techniques.

Podiatrists sometimes require patients to use orthotics (special mechanical contraptions that help in controlling, correcting, or compensating for impaired limb function). Othortics help the patient maintain a good arch and foot alignment. Overtime, this eases the pain.

Chronic Achilles Tendonitis is corrected by surgery. The tendon's swollen outer is removed and all the torn tissues are reattached. A two- to three-week therapy follows the surgery. If the treatment is successful, the patient can resume physical activities in about six to 10 weeks.