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    Achilles Tendinitis: Diagnosis, Treatment and Prevention

    What is the anatomy of Achilles Tendinitis?

    The Achilles tendon, a sturdy band of fibrous tissue, plays a crucial role in foot movement by linking the calf muscles to the heel bone. This vital tendon facilitates actions such as walking, running, and jumping.

    Achilles tendinitis involves structural changes within this tendon caused by repetitive stress or overuse. Microscopic tears, collagen deterioration, and inflammation occur, compromising the tendon's integrity and function. These changes result in pain, swelling, and diminished mobility in the affected area.

    The changed structure and function of the Achilles tendon significantly impact an individual's ability to participate in physical activities. The affected tendon becomes less supple, increasing its susceptibility to further injury and causing reduced mobility and elevated discomfort during activities involving the affected leg.

     

    How can you differentiate between Achilles Tendinitis and other Achilles injuries?

    Achilles TendinitisAchilles Tendon RuptureAchilles Bursitis
    Location of PainPain along the Achilles tendon, often above the heel bone.Sudden, sharp pain is typically felt in the lower calf or heel area.Pain and swelling near the heel but not necessarily along the tendon.
    Nature of DiscomfortGradual onset of pain, stiffness, and tenderness.Sudden and severe pain, is sometimes described as accompanied by the sound of something “popping” or “snapping”.Persistent discomfort is often described as a dull ache or tenderness.
    Swelling and WarmthSwelling and warmth may be present in the affected area.Significant swelling and possible palpable gap or deformity in the tendon.Swelling and tenderness around the heel area.
    Affected ActivitiesPain worsens during physical activity, especially after rest.Difficulty or inability to bear weight or push off the affected foot.Pain experienced during specific movements or weight-bearing activities.
    achilles tendinitis diagnosis and treatment | Avant Orthopaedic

    How is Achilles Tendinitis diagnosed?

     The diagnosis of Achilles Tendinitis is carried out through a combination of several methods by your healthcare professional. The process may include the following steps:

    Physical examination:

    Your doctor will typically start with a physical examination of the affected Achilles tendon, looking for signs of swelling, tenderness, deformity, or thickening. They may also assess the ankle's range of motion to understand any limitations affecting your daily life. This might involve functional tests like calf raises and other exercises stressing the ankle to evaluate the severity of your condition..

    Review of medical history:

    Following the physical examination, your doctor may inquire about your medical history, asking about the sensations experienced during the incident and the activity being performed. They'll also explore any previous injuries or underlying conditions that could increase the risk of Achilles tendinitis.

    Imaging tests:

    If further confirmation is required, your healthcare provider may suggest imaging tests such as an MRI, ultrasound, or X-ray. An MRI offers detailed images, providing a comprehensive view of the tendon's damage. Ultrasound can reveal structural changes within the tendon, offering clear images of any tears or damage. X-rays may be used to examine the heel bone for conditions like bone spurs or calcifications at the tendon insertion point.

    Non-surgical treatment options for Achilles tendinitis include:

    RICE:

    For mild cases of heel tendon pain, healthcare providers commonly recommend RICE: Rest, refraining from activities that strain the affected area; Ice, applying an ice pack to reduce pain and inflammation; Compression, using bandages or wraps to manage swelling; Elevation, ensuring the affected area is elevated with a cushion or pillow to reduce swelling.

    Orthotic Devices:

    Specialised support or inserts, either custom-made or prefabricated, are designed to alleviate stress on the heel. They can alleviate the discomfort felt when performing physical activities, and improve your quality of life.

    Medication:

    Prescribed to manage pain and inflammation, medication is often used alongside other treatments. Consultation with a healthcare provider is crucial before starting any medication regimen.

    Physical Therapy:

    Therapists create personalised plans based on the condition's severity, aiming to strengthen the Achilles tendon and its supporting structures. Exercises may include stretching, strengthening, and flexibility routines tailored to individual needs:

    • Stretching Exercises: Targeted stretching of the Achilles tendon and calf muscles improves flexibility and reduces strain.
    • Strengthening Exercises: Calf raises or toe raises help strengthen the Achilles tendon and surrounding structures, reducing the risk of further injury.
    • Flexibility Improvement: Exercises focus on reducing stiffness and may involve balance and stability exercises to enhance coordination and lower the risk of re-injury.

    Extracorporeal Shock Wave Therapy (ESWT):

    This treatment utilises shock waves directed at the affected area to promote healing, reduce inflammation, and alleviate pain. Administered by a doctor using a handheld device, ESWT stimulates blood flow, offering relief, particularly for conditions unresponsive to other conservative treatments

    Surgical treatment options for Achilles tendinitis include:

    Surgical options for Achilles tendinitis are typically reserved for severe cases unresponsive to conservative treatments:

    Ankle Arthroscopy:

    This minimally invasive procedure involves inserting a small camera (arthroscope) through tiny incisions into the ankle joint. Surgeons use this technique to assess structures within the ankle joint, including the Achilles tendon. It allows identification and potential repair of issues contributing to tendinitis, such as removing damaged tissue or addressing associated joint problems.

    Debridement:

    Debridement surgery entails removing damaged, degenerated, or inflamed tissues from the affected area of the Achilles tendon. Sometimes, the remaining healthy tendon may be reinforced. The goal is to enhance blood flow to damaged areas, fostering the healing process.

    Gastrocnemius recession surgery:

    Gastrocnemius recession surgery, also known as gastrocnemius lengthening or gastrocnemius release, is a surgical procedure to address tightness of the gastrocnemius muscle, one of the major muscles in the calf. This procedure may be performed in two ways: with a conventional, long incision or a small incision and an endoscope. The goal of this surgery is to alleviate excessive tightness in the muscle and allow it to relax.

     

    How can Achilles Tendinitis be prevented?

    Gradual Increase in Activity Level:

    For individuals new to a sport or exercise routine, it's advisable to raise the intensity and frequency of activities incrementally. This approach allows the Achilles tendon to adapt to new stresses, lowering the risk of overuse injuries.

    Selection of Appropriate Footwear:

    Choosing suitable footwear is essential, ensuring proper cushioning for your heel. Consider factors such as adequate cushioning, proper arch support, stability, and overall comfort when selecting footwear.

    Strengthen Your Calf Muscles:

    Developing well-toned calf muscles aids in shock absorption during movements, reducing the impact on the Achilles tendon and the likelihood of overuse injuries. Consider integrating exercises like calf raises and heel drops into your routine to bolster tendon strength.

    Regular Stretching:

    Regular stretching, beyond warm-up and cool-down exercises, benefits not only the Achilles tendon but the entire body. Flexible muscles and tendons are less susceptible to strains, tears, and overuse injuries. Additionally, enhanced joint flexibility reduces the risk of awkward movements that could strain the Achilles tendon.

    Tendon Rupture:

    Prolonged Achilles tendinitis can weaken the tendon's structural integrity, making it more prone to partial tears or, in severe cases, a complete rupture. This rupture can occur suddenly, often during physical activity, and is marked by intense pain, swelling, and an inability to bear weight on the affected leg.

    Reduced Quality of Life:

    Untreated or inadequately managed Achilles tendinitis can significantly restrict an individual's ability to carry out daily activities. Persistent pain, discomfort, and decreased mobility can impact work, recreational pursuits, and daily routines, diminishing the overall quality of life.

    Chronic Pain and Persistent Symptoms:

    Persistent Achilles tendinitis frequently results in chronic pain, stiffness, and discomfort in the affected area. Continuous discomfort and irritation can pose challenges for various activities, disrupt sleep patterns, or cause ongoing pain during movement.

     

    Are you or a loved one suffering from Achilles Tendinitis?

     If you suspect you or someone you care about may be experiencing Achilles tendinitis, it's essential to seek professional medical advice for a proper diagnosis and treatment. Early intervention often leads to better outcomes and a quicker recovery. Book an appointment with us at Avant Orthopaedics today to receive a personalised consultation and suggestions for the most suitable treatments