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Achilles Tendinitis

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The Achilles tendon, which connects the calf muscles to the heel bone, can withstand significant pressure from physical activities. Achilles tendinitis is estimated to account for approximately 11 percent of all running injuries, as the Achilles tendon provides the momentum to push off to walk or run. Achilles tendinitis, also called Achilles tendinopathy, results from overuse, injury or disease of the Achilles tendon, which causes the area to become inflamed.

There are two types of Achilles tendinitis: Non-insertional Achilles Tendinitis – Fibers that are located in the middle portion of the tendon began to develop small tears that cause swelling and thickening. This type of tendinitis is usually found in younger people who are very active. Insertional Achilles Tendinitis – Develops where the tendon attaches to the heel bone in the lower part of the heel. Extra bone growth also called bone spurs form because of this tendinitis and can affect patients at any time, even if they are not active.

Achilles Tendinitis Causes

Achilles tendinitis usually results from overuse and not a specific injury or trauma. When the body is subject to repetitive stress, the Achilles tendon is more prone to become inflamed. Other factors may cause Achilles tendinitis, such as:

  • Sudden increase in physical activity, which can be related to distance, speed or hills, without giving yourself adequate time to adjust to the heightened activity. With running up hills, the Achilles tendon has to stretch more for each stride, which creates rapid fatigue.
  • Inadequate footwear or training surface. High heels may cause a problem, because the Achilles tendon and calf muscles are shortened. While exercising in flat, athletic shoes, the tendon is then stretched beyond its normal range, putting abnormal strain on the tendon.
  • Tight calf muscles which gives the foot a decreased range of motion. The strained calf muscles may also put extra strain on the Achilles tendon.
  • Bone spur where the Achilles tendon attaches to the heel bone, aggravating the tendon and causing pain.

Achilles Tendinitis Symptoms

The Achilles tendon is a strong muscle and is not usually damaged by one specific injury. Tendinitis develops from repetitive stress, sudden increase or intensity of exercise activity, tight calf muscles, or a bone spur that rubs against the tendon. Common signs and symptoms of Achilles Tendinitis include:

  • Gradual onset of pain at the back of the ankle which may develop in several days up to several months to become bothersome.
  • Heel pain during physical activities which may diminish after warming up in early stages, or become a constant problem if the problem becomes chronic.
  • Stiffness at the back of the ankle in the morning.
  • During inactivity, pain eases.
  • Swelling or thickening of the Achilles tendon.
  • Painful sensation if the Achilles tendon is palpated.
  • If a pop is heard suddenly, then there is an increased chance that the Achilles tendon has been torn and immediate medical attention is needed.

Diagnosis

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.

Achilles Tendinitis Treatment Options

There are many nonsurgical ways for treating both forms of tendinitis like resting, putting ice on the area and exercises. Healing of the Achilles tendon can be a slow process, because the area has poor blood supply. If the condition becomes chronic and symptoms do not improve within 6 months, surgery might be needed. Surgical treatment may be suggested if pain has not improved after six months of nonsurgical care. 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.

Risks

Like with any surgery there are risks involved, risks like:

  • Wound infection which can be very difficult to treat
  • Moderate to severe pain, noted in 20-30 percent of patients
  • Damage to the surrounding nerves
  • Damage to the blood vessels
  • Damage to the joint
  • Blood clots
  • Death

Achilles Tendon Rupture

The Achilles tendon is an extension of 2 muscles in the lower leg the gastroncnemius and the soleus and is the thickest and strongest tendon in the body. The Achilles tendon enables people to run, walk, jump, and even stand on their toes. Because of the tendon’s role in the body the Achilles can be subjected to up to 3 to 12 times a person’s body weight when sprinting. This stress can sometimes cause the tendon to tear or rupture. If this happens surgery is needed to repair the tendon. There are many ways to repair the Achilles tendon but in general during the doctors will make an incision on the side of the foot just above the heel. They will then reattach the tendons usually by sewing the two ends together. Due to the fact that the skin when the incision is made is very thin and has poor blood supply, complications are more common than with bunion surgery but new techniques have dramatically reduced the risks from what they were in the past. The recovery time for surgery can take up to eight weeks or more to be fully recovered. Immobilizing the leg can lead to joint stiffness, muscle atrophy, and blood clots so doctors recommend doing motion exercises very soon after surgery. Patients will also wear a splint and will need to use crutches in the first few weeks following surgery.

Achilles Tendon Rupture Causes

The most common reasons for the injury of the Achilles tendon are from:

  • Overuse
  • Misalignment
  • Improper footwear
  • Medication side effects
  • Accidents

Achilles Tendon Rupture Symptoms

A rupture of the Achilles tendon is often reported by patients as hearing a very loud snap followed by a sensation that is similar to being violently kicked in the calf. The calf will swell and the patient will not be able to raise their toes or walk properly.

Risks

Like with any surgery there are risks involved:

  • Infection
  • Possibility that the tendon will not be as strong as before
  • Damage to the surrounding nerves
  • Damage to the blood vessels
  • Damage to the joint
  • Blood clots
  • Difficulty healing
  • Death

Achilles Tendinitis is a procedure that requires attention both before and after treatment. At West Medical, we offer minimally invasive procedures that are effective and have a shorter recovery time than some more traditional methods of treatment. We care about out patients, and we want to make sure you are comfortable before, after and during your surgery. If you are interested in learning more about Los Angeles Achilles tendinitis treatment, please call West Medical at (855) 690-0565 and one of our representatives will be happy to address any of your questions, comments, or concerns.

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