What is Achilles Tendinitis?
Achilles tendinitis explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors
The Achilles tendon is one of the thickest and strongest tendons in the body. This tendon stretches from the calcaneus, or posterior region of the heel bone, to approximately the mid-calf. At approximately six inches in length, the Achilles tendon is involved in extending the foot, pushing off of the ground while walking or running, raising up on the toes, and pointing the toes. The Achilles tendon can sustain pressure of almost four times the weight of one’s body while walking and almost eight times one’s body weight while running.
Generally, Achilles tendinitis is the result of overuse, which leads to tendon deterioration and disorganization of tissue. While the phrase tendinitis typically refers to a swelling of the tendon, this is not always the case for individuals with Achilles tendinitis, though inflammation can occur with the condition.
Individuals suffering from Achilles tendinitis generally report pain in the area of the ankle. This pain can range from a dull ache to a sharp stabbing pain. Though many individuals report that their symptoms occurred suddenly, in some instances the pain and discomfort associated with Achilles tendinitis can have a more gradual onset. It is also common for individuals to report that their ankles are stiffer upon wakening in the morning, that their pain is worse during physical exertion, or that they experience an increase in tendon and joint stiffness the day after they are involved in physical activity.
Patients who are suspected of having Achilles tendinitis generally will undergo a physical examination of the ankle. The physician will also gather information about the patient’s history, details with regard to the current symptoms, and any other relevant information with regard to the onset of the condition. Palpation of the tendon can frequently reveal an audible cracking, indicating underlying damage to the tendon.
Causes of Achilles Tendinitis
Many patients with Achilles tendinitis describe that their pain occurred suddenly, though evidence of tissue damage within the tendon can generally be detected prior to the patient’s reported injury. In fact, the most common cause of difficulties with regard to Achilles tendinitis is through its overuse. Other ways that the Achilles tendon can become damaged or begin to deteriorate is by not completing an appropriate warm-up prior to strenuous physical activity or beginning an activity involving a significant amount of physical exertion following a sedentary period.
Though the Achilles tendon is one of the strongest and thickest tendons in the body and can sustain pressure of multiples times a person’s weight, this tendon can become overloaded. This overload then leads to non-inflammatory thickening and stiffness. Over time, as the tendon continues to sustain large amounts of strain and pressure, the collagen matrix within the tendon maintaining its structure can become disorganized, leading to lesions that can be detected through an ultrasound or magnetic resonance imaging.
Individuals who are engaged in higher levels of activity are believed to be at an increased risk for developing Achilles tendinitis, though the condition can affect anyone. Athletes, runners, or individuals who are involved in sports requiring a lot of jumping are at a higher risk. Individuals who have chronic difficulties with regard to Achilles tendinitis are more likely to have serious long-term complications as a result of the condition. Frequent injury to this tendon without sufficient time to heal can lead to an overall weakening of the cell structure. Further complicating this is the fact that injuries to the Achilles tendon can be somewhat slow to heal, as the tendon does not receive a high level of blood flow to assist in repairing the tissue.
In addition to overuse, some individual factors have been identified in placing a patient at an increased risk for developing Achilles tendinitis. For instance, males are more likely to develop complications with regard to Achilles tendinitis than women. Increasing age, obesity, and a past history of the condition are also known to place an individual at a higher risk for developing Achilles tendinitis.
Treatment for Achilles Tendinitis
Successful treatment of Achilles tendinitis can generally be achieved through methods that can be done at home. Specifically, it is recommended that patients with Achilles tendinitis apply a cold compress to the ankle and wear a heel pad in order to reduce the pressure placed on the tendon. Physical therapy can be highly effective in strengthening a damaged tendon. Over-the-counter pain relievers can be helpful for patients to manage the pain associated with tendon damage. For instance, non-steroidal anti-inflammatory drugs (NSAIDs) can provide pain relief as well as reduce any associated swelling in the area. Patients who report ankle swelling as a result of Achilles tendinitis are encouraged to elevate the affected ankle to help reduce the swelling. Applying a cold compress for approximately 15 to 20 minutes can also promote the reduction of swelling to the area.
In addition, athletes and patients who are highly involved in sports or other exercise routines are strongly encouraged to temporarily reduce the amount of stress that they place on their ankle. While the patient may not be experiencing debilitating symptoms of stiffness, pain, or weakness in the ankle, the tendon may not be completely healed. Without allowing for complete recovery, individuals place themselves at risk for reinjuring the Achilles tendon.
More persistent and chronic instances of Achilles tendinitis may require the use of a cast, brace, or boot in order to demobilize the foot and allow the tendon to be protected from repeated stress or re-injury while it is healing. Steroid injections are also available for patients who experience significant degrees of pain that does not respond to other methods of pain management. This method of pain relief can be highly effective for providing patients with relief from pain, however, it does increase the risk of tendon rupture. Generally, this process involves the injection of corticosteroids into the affected tendon or into the joint and the area surrounding the tendon.
For instances of Achilles tendinitis that have been unresponsive to other treatments, surgery may be recommended. In cases where the Achilles tendon has ruptured, the only treatment option is surgical intervention.
Frequently occurring among athletes, Achilles tendinitis involves damage to the Achilles tendon that is located at the back of the heel. Patients with Achilles tendinitis frequently report experiencing stiffness, swelling, pain, and discomfort in the ankle.
Though many patients with Achilles tendinitis explain that their symptoms occurred as the result of an acute event, typically the degeneration and weakening of the Achilles tendon had already begun. Many risk factors have been identified in placing an individual at risk for developing Achilles tendinitis. Males are more likely to experience difficulties with regard to this condition than females. Obesity is also a risk factor. Achilles tendinitis can be effectively treated using conservative techniques, such as application of a cold compress or by using a brace. However, for patients experiencing a significant amount of pain, steroid injections may be a helpful option. In terms of tendon rupture, the only treatment option available is surgery.
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