The Achilles tendon is
the thickest and strongest tendon in your body, connecting your calf muscles to the back of your heel. Virtually all of the force generated when you ?toe off? the ground during running is transmitted
by the Achilles, and this force can be as much as three times your body weight. And the faster you run, the more strain you put on the Achilles tendon. As such, it?s prone to injury in many runners,
but particularly those who do a lot of fast training, uphill running, or use a forefoot-striking style. Achilles tendon injuries account for 5-12% of all running injuries, and occur
disproportionately in men. This may be because of the faster absolute speeds men tend to train at, or may be due to other biomechanical factors.
Short of a trauma, the primary cause of Achilles tendonitis is when the calf muscle is so tight that the heel is unable to come down to the ground placing extreme stress on the Achilles tendon at the
insertion. Keep in mind that the calf muscle is designed to contract up, lifting the heel bone off the ground, propelling you forwards to the front of the foot for push off. When the calf is so tight
that the heel is prevented from coming down on the ground there will be stress on the tendon and the foot will over pronate causing the Achilles tendon to twist, adding to the stress on the
insertion. Improper treatment may lead to a more severe injury, such as a rupture or chronic weakening, which may require surgery.
Common symptoms of Achilles tendinitis include weakness in the leg, slight pain above the heel in the lower leg after activity, feeling of stiffness in the leg that usually appears in the morning and
lessens throughout the day, bad pain the day after exercising, pain as you climb stairs or go uphill, swelling in the area of the Achilles tendon, creaking or cracking noise when you press on the
During an examination of the foot and ankle, you doctor will look for the following signs, Achilles tendon swelling or thickening. Bone spurs appearing at the lower part of the tendon at the back of
the hell. Pain at the middle or lower area of the Achilles tendon. Limited range of motion of the foot and ankle, and a decreased ability to flex the foot. Your doctor may perform imaging tests, such
as X-rays and MRI scans, to make a diagnosis of Achilles tendinitis. X-rays show images of the bones and can help the physician to determine if the Achilles tendon has become hardened, which
indicated insertional Achilles tendinitis. MRI scans may not be necessary, but they are important guides if you are recommended to have surgical treatment. An MRI can show the severity of the damage
and determine what kind of procedure would be best to address the condition.
The recommended treatment for Achilles tendinitis consists of icing, gentle stretching, and modifying or limiting activity. Nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen or
naprosyn, can reduce pain and swelling. Physical therapy and the use of an orthosis (heel lift) can also be helpful. For chronic cases where tendinosis is evident and other methods of treatment have
failed, surgery may be recommended to remove and repair the damaged tissue.
There are three common procedures that doctor preform in order help heal the tendinitis depending on the location of the tendinitis and amount of damage to the tendon, including: Gastrocnemius
recession - With this surgery doctors lengthen the calf muscles because the tight muscles increases stress on the Achilles tendon. The procedure is typically done on people who have difficulty
flexing their feet even with constant stretching. Debridement and Repair - When there is less than 50% damage in the tendon, it is possible for doctors to remove the injured parts and repair the
healthy portions. This surgery is most done for patients who are suffering from bone spurs or arthritis. To repair the tendon doctors may use metal or plastic anchors to help hold the Achilles tendon
in place. Patients have to wear a boot or cast for 2 weeks or more, depending and the damage done to the tendon. Debridement with Tendon Transfer - When there is more the 50% damage done to the
Achilles tendon, and Achilles tendon transfer is preformed because the remain healthy tissue is not strong enough. The tendon that helps the big toe move is attached to give added strength to the
damaged Achilles. After surgery, most patients don?t notice any difference when they walk or run.
As with all injuries, prevention is your best defense especially with injuries that are as painful and inconvenient as Achilles tendonitis. Options for how to prevent Achilles tendonitis include,
stretching- Stretching properly, starting slowly, and increasing gradually will be critical if you want to avoid Achilles tendonitis. To help maintain flexibility in the ankle joint, begin each day
with a series of stretches and be certain to stretch prior to, and after, any exercise or excessive physical activity. Orthotics and Heel Support- Bio-mechanically engineered inserts and heel cups
can be placed in your shoes to correct misalignments or bolster the support of your foot and are available without a prescription. The temporary heel padding that these provide reduces the length
that the Achilles tendon stretches each time you step, making it more comfortable to go about your daily routine. Proper Footwear- Low-heeled shoes with good arch support and shock absorption are
best for the health of your foot. Look into heel wedges and other shoe inserts to make sure that your everyday foot mechanics are operating under ideal conditions.