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What Is The Primary Cause Of Achilles Tendonitis ?

Overview

Achilles TendinitisAchilles tendinitis is often a misnomer, as most problems associated with the Achilles tendon are not strictly an inflammatory response. A more appropriate term, which most experts now use, is Achilles tendinopathy which includes, Tendinosis, microtears in the tissues in and around the tendon. Tendinitis, inflammation of the tendon Most cases of Achilles tendon pain is the result of tendinosis. Tendon inflammation (tendinitis) is rarely the cause of tendon pain. Achilles tendinopathy is a common condition that occurs particularly in athletes and can be difficult to treat due to the limited vascular supply of the tendon and the stress within the Achilles tendon with every step. Evidence indicates that treatment incorporating custom foot orthoses can improve this condition by making the foot a more effective lever in gait. A 2008 study reported between 50 and 100% relief (average 92%) from Achilles tendinopathy symptoms with the use of custom foot orthoses.

Causes

Achilles tendinitis may be caused by intensive hill running, sprinting, or stair climbing. Overuse resulting from the natural lack of flexibility in the calf muscles. Rapidly increasing intensity of exercise, especially after a period of inactivity. Sudden and hard contraction of the calf muscles when exerting extra effort, like that in a final sprint or high jump.

Symptoms

Pain in the back of the heel that can be a shooting pain, burning pain or even an intense piercing pain. Swelling, tenderness and warmth over the Achilles tendon especially at the insertion of the tendon to the calcaneous, which may even extend into the muscle of the calf. Difficulty walking, sometimes the pain makes walking impossible. Pain that is aggravated by activities that repeatedly stress the tendon, causing inflammation or pain that occurs in the first few steps of the morning or after sitting down for extended periods of time which gets better with mild activity. It is important to note though that achilles tendinosis can develop gradually without a history of trauma.

Diagnosis

If Achilles tendonitis is suspected, avoid any exercise or activity that causes the pain. It is advisable to see a doctor promptly so that an accurate diagnosis can be made and appropriate treatment recommended. The doctor will take a full medical history and will ask about the nature and duration of the symptoms. They will perform a physical examination of the affected area. Ultrasound scanning may be used to assess damage to the tendon or surrounding structures. Occasionally MRI (magnetic resonance imaging) may be recommended. The symptoms of Achilles tendonitis are often similar to symptoms of other conditions such as partial Achilles tendon rupture and heel bursitis. This can make diagnosis difficult and a referral to an orthopaedic specialist may be required in order for an accurate diagnosis to be made.

Nonsurgical Treatment

Proper footwear with a strong and secure counter (the heel circumference) may help to encourage heeling of the tendon. A tendinitis will occasionally resolve on it?s own, with rest, ice, and gentle stretching. If symptoms persist for more than 2 weeks, consult your physician. Your physician may suggest physiotherapy and custom orthotics. Physiotherapy can suggest appropriate exercises and modalities to aid in the healing process. Custom orthotics can be very successful in treating the problem, as the original cause may be due to an improper alignment of the foot and heel. Re-aligning the foot to a neutral position may provide an optimal, biomechanically sound environment for healing to occur.

Achilles Tendinitis

Surgical Treatment

Most people will improve with simple measures or physiotherapy. A small number continue to have major problems which interfere with their lifestyle. In this situation an operation may be considered. If an operation is being considered, the surgeon will interview you and examine you again and may want you to have further treatment before making a decision about an operation. Before undergoing Achilles tendonitis surgery, London based patients, and those who can travel, will be advised to undergo a scan, which will reveal whether there is a problem in the tendon which can be corrected by surgery. Patients will also have the opportunity to ask any questions and raise any concerns that they may have, so that they can proceed with the treatment with peace of mind.

Prevention

Your podiatrist will work with you to decrease your chances of re-developing tendinitis. He or she may create custom orthotics to help control the motion of your feet. He or she may also recommend certain stretches or exercises to increase the tendon's elasticity and strengthen the muscles attached to the tendon. Gradually increasing your activity level with an appropriate training schedule-building up to a 5K run, for instance, instead of simply tackling the whole course the first day-can also help prevent tendinitis.

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