Achilles Tendonitis

Arthritis-Achilles Tendonitis.jpg Achilles tendonitis is an inflammation of the Achilles tendon, sometimes called the heel cord, which connects the calf muscles to the heel bone. It is usually the result of an injury or tiny tears in the tendon fibers.

Two types exist:
• Insertion, where the tendon attaches to the heel bone
• Non-insertional, which occurs slightly higher up the tendon

DIAGNOSIS

Multiple factors may cause Achilles tendonitis. The most common is overuse of the tendon. Often, a sudden increase in athletic training, running, mileage, or speed will bring on symptoms. Pressure from the hard back of an athletic shoe can irritate the tendon over the heel. Landing hard on the arch of the foot may contribute to the strain on the Achilles tendon. Diagnosis is based on the symptoms and signs discussed above. This condition is difficult to see on an X-ray, but sometimes hardening of the tendon can be observed, or an abnormal piece of bone or bone spur is seen where the tendon connects to the back of the heel. X-rays may also show an unusual bump of the heel, which can rub and irritate the tendon.

SYMPTOMS

Achilles tendonitis is associated with heel or ankle pain, usually slow in onset, and a limp, causing trouble running and jumping. Exercise can make the symptoms either better or worse. The discomfort varies from being just a nuisance to being very painful and restrictive. The back of the shoe may cause painful pressure on the attachment of the tendon to the heel bone. Sensitivity at the site of inflammation is a consistent sign.

For non-insertional tendonitis, swelling is frequently seen and felt. Sometimes there is a rubbing feeling with gliding of the tendon as the ankle moves back and forth. The person may have difficulty walking on his or her toes because of pain in the tendon. Pain and swelling should be monitored for any worsening. Feeling a sudden "pop" usually means the tendon has ruptured, which requires a cast or surgery to avoid permanent disability.

TREATMENT

Achilles tendonitis will often respond to rest or changes in activity, stretching, or ice after activity. Non-steroidal anti- inflammatory drugs (NSAIDs), such as ibuprofen or naproxen may also help.

Physical therapy focusing on stretching and strengthening, massage, alternating hot and cold baths, and ultrasound or sound waves can also help with healing and comfort. The temporary use of a heel lift or the insertion of an arch support, called an orthotic, into the shoe or sneaker can also help.

Although seldom necessary, the ankle may be kept in a short leg cast or splint. Surgery is rarely needed but can remove bone spurs or the bony prominence of the heel bone.