By: Camryn Cothran, SPT; Dr. Darryl Richmond, PT, DPT, MSc.
The achilles tendon is the largest, strongest, and thickest tendon in the body connecting the gastrocnemius and soleus to the calcaneus. Due to its limited blood supply, this tendon is at an increased risk of injury and even more susceptible to further damage when the tendon experiences an increase in load. Continued loading of the tendon leads to micro-trauma and inflammation such as the back of one’s shoe rubbing up against the tendon. Factors that make someone more prone to an achilles tendon injury are: if you are a male over the age of 30, just beginning a new sport, or have recently increased your level of activity. The most common achilles tendon conditions are tendonitis, peritendinitis, tendinosis, rupture, and retrocalcaneal-bursitis. (Mazzone & Mccue, 2002)
What is Achilles Tendonitis?
Achilles tendonitis is the inflammation of the achilles tendon that can be caused by improper fitting of shoes, improper technique, excessive pronation, poor flexibility of the ankle, or tight calf muscles. It’s commonly found in athletes that place a repetitive amount of stress onto the tendon such as runners, dancers, gymnasts, and tennis players. (Mazzone & Mccue, 2002)
There are two types of achilles tendonitis: non-insertional achilles tendonitis and insertional achilles tendonitis.
Non-insertional Achilles Tendonitis - fibers begin to break down and tiny tears develop at the middle portion of the tendon.
Insertional Achilles Tendonitis - damage to the fibers on the lower portion of the tendon near the heel bone.
Symptoms of Achilles Tendonitis
Pain or tenderness proximal to where the tendon inserts onto the calcaneus
Pain worsens with strenuous activity
Pain lessens when walking or when heat is applied to the area
The appearance of a bump on the heel (bone spur formation)
Symptoms increase gradually
Achilles Tendonitis typically occurs because the tendon is experiencing recurring forces and can't properly heal. Decreasing exercise, resting from playing sports, or engaging in low impact exercises such as swimming or biking is very significant in the recovery phase. In conjunction with resting, the use of ice and non-steroidal anti-inflammatory drugs can help control inflammation and pain. For long term relief, attending physical therapy, buying appropriate shoes and heel lifts, or losing weight to reduce further inflammation of the tendon will help with the amount of strain on the tendon.
Another treatment that has been rendered effective in physical therapy is extracorporeal shockwave therapy. It is the use of high or low energy shockwaves to promote healing in the damaged tendon. Another resource can be the use of night splinting. Night splinting relieves stiffness you may feel in the morning by wearing a brace that keeps your foot in a dorsiflexed position while sleeping at night. This relieves tension on the achilles tendon and maintains the flexibility of the calf muscles. If the use of heel lifts, buying appropriate shoes, physical therapy, or losing weight hasn’t changed anything over the course of 6 months, surgery will be recommended to remove the inflamed tissue and the remove bone spurs if necessary. (Conyer, et. Al 2022)
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