Achilles Tendonitis’
The Achilles tendon is the largest and strongest tendon in the body and attaches the heel to the calf muscle. Where other tendons are covered with a synovial sheath the Achilles tendon is covered by a thin fatty membrane called a Paratenon which allows the tendon to move freely and provides blood supply to the structure. The preferred term for this injury is “tendonopathy” rather than “tendonitis” (“itis” = inflammation) due to there being generally poor blood supply (or subsequent inflammation) found in the tendon itself.
Causes of tendonopathy
The most common cause of injury is ageing, high velocity sport, ineffective foot function and bodyweight, however medication such as Warfarin, Ciprofloxacin and the antibiotic fluoroquinolone have been known to cause rupture in a small number of people. Achilles tendinitis is very common among running athletes.
Ineffective foot function such as Functional Hallux limitus (big toe joint not flexing adequately during gait) and other sagital plane blockades such as ankle, knee and hip flexion problems are all known to place greater pressure on this structure.
Pathology
Tendonopathy – 55-65% of injuries caused by either
Peritendonitis – Swelling of the paratenon.
Tendonosis – Tendon becomes thick or fluid in the tendon.
Insertional tendonopathy – 20-25% injuries
Calcaneal spur usually evident on MRI imaging.
Bursitis – up to 20% of cases
Swelling of the bursa (fluid filled sack) at the base of the Achilles, however this usually occurs with a tendonopathy.
Signs & Symptoms
The primary symptom of Achilles tendonopathy is pain in the back of the heel or above the heel towards the calf muscle. This usually increases with exercise and lasts for a period afterwards.
Diagnosis
On examination peritendonitis can be painful when squeezed between the fingers. When placed on stretch may not be as painful thus indicating a different pathology. In either case your podiatrist should utilise Diagnostic Ultrasound to confirm any diagnosis. If you think that you have an Achilles Tendonopathy seek the consultation of our Specialist Sports Podiatrist Aengus as incorrect diagnosis may lead to a longer recovery and possible future complications.
Treatment
The underlying cause of the injury should be dealt with to prevent the problem from recurring. The usual treatment of rest, ice, compression and elevation (RICE) with the use of NSAID’s is the first port of call. Following dealing with the underlying cause a graduated programme including eccentric AND concentric strength training is initiated. Here at Footfocus we can utilise the most advanced medical treatments from guided injection to shockwave therapy to get you back to fitness, fast.
Sports podiatrists are best suited to help with this injury. At Foot Focus we can help get you back to your best in the shortest time possible. If you suffer from pain at the back of your heel contact us for the most comprehensive and effective treatment available.