(tendonitis) or Achilles tendon inflammation occurs when the Achilles tendon becomes inflamed, as a result, of the Achilles tendon being put under too much strain. The Achilles tendon joins the calf
muscles to the heel bone, and is found at the back of a person's lower leg. It is the largest tendon in the body and can endure great force, but is still susceptible to injury. Achilles tendinitis is
usually the result of strenuous, high impact exercise, such as running. If ignored, Achilles tendinitis can lead to the tendon tearing or rupturing, and therefore it is important to seek the
necessary treatment. Sometimes, treatment can be as simple as getting rest or changing an exercise routine. However, in more severe cases, surgery may be required.
Tight or tired calf muscles, which transfer too much of the force associated with running onto the Achilles tendon. Not stretching the calves properly or a rapid increase in intensity and frequency
of sport training can make calf muscles fatigued. Activities which place a lot of stress on the achilles tendon, such as hill running and sprint training, can also cause Achilles Tendinitis. Runners
who overpronate (roll too far inward on their feet during impact) are most susceptible to Achilles Tendinitis. Runners with flat feet are susceptible to Achilles Tendinitis because flat feet cause a
'wringing out' effect on the achilles tendon during running. High arched feet usually absorb less shock from the impact of running so that shock is transferred to the Achilles tendon. Use of
inappropriate footwear when playing sport or running e.g., sandals, can also put an extra load on the Achilles tendon. Shoes are now available that have been designed for individual sports and
provide cushioning to absorb the shock of impact and support for the foot during forceful movements. Training on hard surfaces e.g., concrete, also increases the risk of Achilles Tendinitis. Landing
heavily or continuously on a hard surface can send a shock through the body which is partly absorbed by the Achilles tendon. A soft surface like grass turf helps to lessen the shock of the impact by
absorbing some of the force of the feet landing heavily on the ground after a jump or during a running motion.
Mild ache in the back of the lower leg, especially after running. More acute pain may occur after prolonged activity, Tenderness or stiffness in the morning. In most cases the pain associated with
Achilles tendinitis is more annoying than debilitating, making sufferers regret activity after the fact, but not keeping them from doing it. More severe pain around the Achilles tendon may be a
symptom of a much more serious ruptured tendon.
Studies such as x-rays and MRIs are not usually needed to make the diagnosis of tendonitis. While they are not needed for diagnosis of tendonitis, x-rays may be performed to ensure there is no other
problem, such as a fracture, that could be causing the symptoms of pain and swelling. X-rays may show evidence of swelling around the tendon. MRIs are also good tests identify swelling, and will show
evidence of tendonitis. However, these tests are not usually needed to confirm the diagnosis; MRIs are usually only performed if there is a suspicion of another problem that could be causing the
symptoms. Once the diagnosis of tendonitis is confirmed, the next step is to proceed with appropriate treatment. Treatment depends on the specific type of tendonitis. Once the specific diagnosis is
confirmed, the appropriate treatment of tendonitis can be initiated.
In most cases, nonsurgical treatment options will provide pain relief, although it may take a few months for symptoms to completely subside. Even with early treatment, the pain may last longer than 3
months. If you have had pain for several months before seeking treatment, it may take 6 months before treatment methods take effect. The first step in reducing pain is to decrease or even stop the
activities that make the pain worse. If you regularly do high-impact exercises (such as running), switching to low-impact activities will put less stress on the Achilles tendon. Cross-training
activities such as biking, elliptical exercise, and swimming are low-impact options to help you stay active. Placing ice on the most painful area of the Achilles tendon is helpful and can be done as
needed throughout the day. This can be done for up to 20 minutes and should be stopped earlier if the skin becomes numb. A foam cup filled with water and then frozen creates a simple, reusable ice
pack. After the water has frozen in the cup, tear off the rim of the cup. Then rub the ice on the Achilles tendon. With repeated use, a groove that fits the Achilles tendon will appear, creating a
"custom-fit" ice pack. Drugs such as ibuprofen and naproxen reduce pain and swelling. They do not, however, reduce the thickening of the degenerated tendon. Using the medication for more than 1 month
should be reviewed with your primary care doctor. The following exercise can help to strengthen the calf muscles and reduce stress on the Achilles tendon. Lean forward against a wall with one knee
straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the
position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch. Physical therapy is very helpful in treating Achilles
tendinitis. It has proven to work better for noninsertional tendinitis than for insertional tendinitis. Eccentric strengthening is defined as contracting (tightening) a muscle while it is getting
longer. Eccentric strengthening exercises can cause damage to the Achilles tendon if they are not done correctly. At first, they should be performed under the supervision of a physical therapist.
Once mastered with a therapist, the exercises can then be done at home. These exercises may cause some discomfort, however, it should not be unbearable. Stand at the edge of a stair, or a raised
platform that is stable, with just the front half of your foot on the stair. This position will allow your heel to move up and down without hitting the stair. Care must be taken to ensure that you
are balanced correctly to prevent falling and injury. Be sure to hold onto a railing to help you balance. Lift your heels off the ground then slowly lower your heels to the lowest point possible.
Repeat this step 20 times. This exercise should be done in a slow, controlled fashion. Rapid movement can create the risk of damage to the tendon. As the pain improves, you can increase the
difficulty level of the exercise by holding a small weight in each hand. This exercise is performed similarly to the bilateral heel drop, except that all your weight is focused on one leg. This
should be done only after the bilateral heel drop has been mastered. Cortisone, a type of steroid, is a powerful anti-inflammatory medication. Cortisone injections into the Achilles tendon are rarely
recommended because they can cause the tendon to rupture (tear).
Your doctor may recommend surgery if, after around six months, other treatments haven?t worked and your symptoms are having an impact on your day-to-day life. Surgery involves removing damaged areas
of your tendon and repairing them.
Warm up slowly by running at least one minute per mile slower than your usual pace for the first mile. Running backwards during your first mile is also a very effective way to warm up the Achilles,
because doing so produces a gentle eccentric load that acts to strengthen the tendon. Runners should also avoid making sudden changes in mileage, and they should be particularly careful when wearing
racing flats, as these shoes produce very rapid rates of pronation that increase the risk of Achilles tendon injury. If you have a tendency to be stiff, spend extra time stretching. If you?re overly
flexible, perform eccentric load exercises preventively. Lastly, it is always important to control biomechanical alignment issues, either with proper running shoes and if necessary, stock or custom