Achilles Tendonitis

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Achilles Tendonitis is a condition of irritation and inflammation of the large tendon in the back of the ankle. It is a common overuse injury that tends to occur in middle-age recreational athletes. The overuse causes inflammation that can lead to pain and swelling. Furthermore, it can lead to small tears within the tendon, and make it susceptible to rupture. The condition occurs in approximately 6–18% of runners, and also is more common in athletes, especially in sports that involve jumping, and in people who do a lot of walking. Achilles tendonitis that occurs as a result of arthritis in the heel is more common in people who are middle aged and older.
There are three stages of tendon inflammation:
1. Peritenonitis
2. Tendinosis
3. Peritenonitis with tendinosis

Peritenonitis is characterized by localized pain during or following activity. As this condition progresses, pain often develops earlier on during activity, with decreased activity, or while at rest.
Tendinosis is a degenerative condition that usually does not produce symptoms. It may cause swelling or a hard knot of tissue on the back of the leg.
Peritenonitis with tendinosis results in pain and swelling with activity. As this condition progresses, partial or complete tendon rupture may occur.

Symptoms usually include pain in the heel when walking or running. The tendon is usually painful to touch and the skin over the tendon may be swollen and warm.

Poorly conditioned athletes are at the highest risk for developing Achilles tendonitis. Participating in activities that involve sudden stops and starts and repetitive jumping increases the risk for the condition. It often develops following sudden changes in activity level, training on poor surfaces, or wearing inappropriate footwear.
Achilles tendonitis may be caused by a single incident of overstressing the tendon, or it may result from a series of stresses that produce small tears over time.
The condition also may develop in people who exercise infrequently and in those who are just beginning an exercise program, because inactive muscles and tendons have little flexibility because of inactivity. It is important for people who are just starting to exercise to stretch properly, start slowly, and increase gradually.

Treatment for Achilles tendonitis depends on the severity of the injury. If heel pain, tenderness, swelling, or discomfort in the back of the lower leg occurs, physical activity that produces the symptoms should be discontinued.
If the problem returns or persists, a medical professional should be consulted. If pain develops even with proper stretching and training techniques, the patient should consult a podiatrist to check for hyperpronation and adequate arch support. The addition of an orthotic may be enough to maintain good arch and foot alignment and eliminate pain.
If damage to the tendon is minor, the injury may respond to a simple course of treatment known as RICE (rest, ice, compression, elevation).
Patients are advised to:

  • rest the tendon by keeping off their feet as much as possible;
  • apply ice packs for 20 minutes at a time every hour for a day or two to reduce swelling;
  • compress the ankle and foot with a firmly (not tightly) wrapped elastic bandage; and
  • elevate the foot whenever possible to minimize swelling.

  • A nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen may be used to reduce pain, swelling, and inflammation.

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