Overview
Achilles tendinosis (also known as Achilles tendinopathy) is a soreness and stiffness that comes on gradually and continues to worsen until treated. It is a common injury among middle and long distance runners. The severity of Achilles tendinosis can be broken down into four stages, each of which can be measured in terms of how the Achilles tendon feels during exercise, the amount of stiffness and creaking, and Achilles tendon?s soreness to the touch (the Achilles tendon pinch test). The four stages, or grades, are, No pain during exercise, but there is some discomfort in the morning when first getting out of bed. The stiffness and creaking go away after a few minutes and are fine the rest of the day. Lightly pinching the Achilles tendon with the forefinger and thumb in the morning or after exercise will probably indicate soreness. Pain during exercise or running, but performance is not affected. The stiffness and creaking continue to appear when first getting out of bed and continue to disappear shortly afterward. Lightly pinching the Achilles tendon with the forefinger and thumb in the morning or after exercise will indicate soreness. Pain during exercise or running that is detrimental to performance. The stiffness and creaking continue to appear when first getting out of bed, but may continue for some time and reappear at other points during the day. Lightly pinching the Achilles tendon with the forefinger and thumb in the morning or after exercise will indicate soreness. Hurts too much to exercise or run. The stiffness and creaking continue to appear when first getting out of bed, but may continue for most of the day. Lightly pinching the Achilles tendon with the forefinger and thumb at almost any time of day will indicate soreness.
Causes
The calf is under a lot of strain when running: it is not only put on stretch during landing of the foot, but it also has to produce the tension needed to support body weight and absorb the shock of landing. This is what is called an ?eccentric load?. Excessive eccentric loading - either by way of a dramatic increase in mileage, or excessive hill running, or faulty running posture - could very well be the cause of a runner?s achilles tendinitis. The calf strain translates downward into the achilles tendon where it attaches to the heel, and inflammation ensues. Inflammation then causes scarring and fibrosis of tissues, which in turn inflicts pain upon stretching or use. Risk factors for Achilles tendinitis also include spending prolonged amounts of time standing or walking.
Symptoms
The most common site of Achilles Tendonitis is at the heel to 4 inches above the heel. The diagnosis of this problem is made when the following signs are present. Pain in the Achilles tendon with up and down movement of the foot at the ankle. Pain in the Achilles tendon when you squeeze the tendon from side to side. If you are unable to move the foot either up or down, or you have intense pain when trying to walk, you may have a tear of the Achilles tendon, and you should see a doctor immediately. Also if you have severe pain in the calf, with or without discolorations of the skin, you may have a blood clot, and this is a medical emergency; see a doctor immediately. If you do not fall into either of these categories then try the following suggestions.
Diagnosis
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose an Achilles injury such as Achilles tendonitis. Occasionally, further investigations such as an Ultrasound, X-ray or MRI scan may be required to assist with diagnosis and assess the severity of the condition.
Nonsurgical Treatment
In order to treat the symptoms, antiflogistics or other anti-inflammatory therapy are often used. However these forms of therapy usually cannot prevent the injury to live on. Nevertheless patients will always have to be encouraged to execute less burdening activities, so that the burden on the tendon decreases as well. Complete immobilisation should however be avoided, since it can cause atrophy. Passive rehabilitation, Mobilisations can be used for dorsiflexion limitation of the talocrural joint and varus- or valgus limitation of the subtalar joint. Deep cross frictions (15 min). It?s effectiveness is not scientifically proven and gives limited results. Recently, the use of Extracorporal Shock Wave Therapy was proven. Besides that, the application of ice can cause a short decrease in pain and in swelling. Even though cryotherapy 2, 5 was not studied very thoroughly, recent research has shown that for injuries of soft tissue, applications of ice through a wet towel for ten minutes are the most effective measures. Active rehabilitation, An active exercise program mostly includes eccentric exercises. This can be explained by the fact that eccentric muscle training will lengthen the muscle fibres, which stimulates the collagen production. This form of therapy appears successful for mid-portion tendinosis, but has less effect with insertion tendinopathy. The sensation of pain sets the beginning burdening of the patient and the progression of the exercises.
Surgical Treatment
Surgery is considered the last resort. It is only recommended if all other treatment options have failed after at least six months. In this situation, badly damaged portions of the tendon may be removed. If the tendon has ruptured, surgery is necessary to re-attach the tendon. Rehabilitation, including stretching and strength exercises, is started soon after the surgery. In most cases, normal activities can be resumed after about 10 weeks. Return to competitive sport for some people may be delayed for about three to six months.
Prevention
To prevent Achilles tendonitis or tendonosis from recurring after surgical or non-surgical treatment, the foot and ankle surgeon may recommend strengthening and stretching of the calf muscles through daily exercises. Wearing proper shoes for the foot type and activity is also important in preventing recurrence of the condition.
Achilles tendinosis (also known as Achilles tendinopathy) is a soreness and stiffness that comes on gradually and continues to worsen until treated. It is a common injury among middle and long distance runners. The severity of Achilles tendinosis can be broken down into four stages, each of which can be measured in terms of how the Achilles tendon feels during exercise, the amount of stiffness and creaking, and Achilles tendon?s soreness to the touch (the Achilles tendon pinch test). The four stages, or grades, are, No pain during exercise, but there is some discomfort in the morning when first getting out of bed. The stiffness and creaking go away after a few minutes and are fine the rest of the day. Lightly pinching the Achilles tendon with the forefinger and thumb in the morning or after exercise will probably indicate soreness. Pain during exercise or running, but performance is not affected. The stiffness and creaking continue to appear when first getting out of bed and continue to disappear shortly afterward. Lightly pinching the Achilles tendon with the forefinger and thumb in the morning or after exercise will indicate soreness. Pain during exercise or running that is detrimental to performance. The stiffness and creaking continue to appear when first getting out of bed, but may continue for some time and reappear at other points during the day. Lightly pinching the Achilles tendon with the forefinger and thumb in the morning or after exercise will indicate soreness. Hurts too much to exercise or run. The stiffness and creaking continue to appear when first getting out of bed, but may continue for most of the day. Lightly pinching the Achilles tendon with the forefinger and thumb at almost any time of day will indicate soreness.
Causes
The calf is under a lot of strain when running: it is not only put on stretch during landing of the foot, but it also has to produce the tension needed to support body weight and absorb the shock of landing. This is what is called an ?eccentric load?. Excessive eccentric loading - either by way of a dramatic increase in mileage, or excessive hill running, or faulty running posture - could very well be the cause of a runner?s achilles tendinitis. The calf strain translates downward into the achilles tendon where it attaches to the heel, and inflammation ensues. Inflammation then causes scarring and fibrosis of tissues, which in turn inflicts pain upon stretching or use. Risk factors for Achilles tendinitis also include spending prolonged amounts of time standing or walking.
Symptoms
The most common site of Achilles Tendonitis is at the heel to 4 inches above the heel. The diagnosis of this problem is made when the following signs are present. Pain in the Achilles tendon with up and down movement of the foot at the ankle. Pain in the Achilles tendon when you squeeze the tendon from side to side. If you are unable to move the foot either up or down, or you have intense pain when trying to walk, you may have a tear of the Achilles tendon, and you should see a doctor immediately. Also if you have severe pain in the calf, with or without discolorations of the skin, you may have a blood clot, and this is a medical emergency; see a doctor immediately. If you do not fall into either of these categories then try the following suggestions.
Diagnosis
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose an Achilles injury such as Achilles tendonitis. Occasionally, further investigations such as an Ultrasound, X-ray or MRI scan may be required to assist with diagnosis and assess the severity of the condition.
Nonsurgical Treatment
In order to treat the symptoms, antiflogistics or other anti-inflammatory therapy are often used. However these forms of therapy usually cannot prevent the injury to live on. Nevertheless patients will always have to be encouraged to execute less burdening activities, so that the burden on the tendon decreases as well. Complete immobilisation should however be avoided, since it can cause atrophy. Passive rehabilitation, Mobilisations can be used for dorsiflexion limitation of the talocrural joint and varus- or valgus limitation of the subtalar joint. Deep cross frictions (15 min). It?s effectiveness is not scientifically proven and gives limited results. Recently, the use of Extracorporal Shock Wave Therapy was proven. Besides that, the application of ice can cause a short decrease in pain and in swelling. Even though cryotherapy 2, 5 was not studied very thoroughly, recent research has shown that for injuries of soft tissue, applications of ice through a wet towel for ten minutes are the most effective measures. Active rehabilitation, An active exercise program mostly includes eccentric exercises. This can be explained by the fact that eccentric muscle training will lengthen the muscle fibres, which stimulates the collagen production. This form of therapy appears successful for mid-portion tendinosis, but has less effect with insertion tendinopathy. The sensation of pain sets the beginning burdening of the patient and the progression of the exercises.
Surgical Treatment
Surgery is considered the last resort. It is only recommended if all other treatment options have failed after at least six months. In this situation, badly damaged portions of the tendon may be removed. If the tendon has ruptured, surgery is necessary to re-attach the tendon. Rehabilitation, including stretching and strength exercises, is started soon after the surgery. In most cases, normal activities can be resumed after about 10 weeks. Return to competitive sport for some people may be delayed for about three to six months.
Prevention
To prevent Achilles tendonitis or tendonosis from recurring after surgical or non-surgical treatment, the foot and ankle surgeon may recommend strengthening and stretching of the calf muscles through daily exercises. Wearing proper shoes for the foot type and activity is also important in preventing recurrence of the condition.