DESCRIPTION & CAUSES
Achilles Tendonitis is an inflammation of the Achilles Tendon. This tendon attaches the muscles in the calf of the leg to the back of our heels. The Achilles Tendon is a long and thick tendon, which moves our foot down, so that the toes point to the ground (plantar flexion). This tendon can become inflamed due to the following causes:
- Over utilizing it, such as too much running, especially up or down hill.
- Trauma, such as a kick to the tendon.
- Shoe or boot pressure, especially at its attachment to the heel, or just above it.
There are over 250,000 injuries to the Achilles Tendon annually. In fact, more Than 10% of all running injuries are to the Achilles tendon.
Tendonitis may be classified as either acute or chronic
Acute Achilles Tendonitis comes on quickly, usually after a specific activity or event. It is characterized by an overstretching or tearing of some of the small fibers of the tendon, and causes pain or tenderness when walking or running. It can occur at the insertion (near the attachment to the heel bone, or further up the leg, about 4 or 5 inches above the heel. Acute tendonitis can also follow a specific injury, such as a kick to the tendon while playing soccer.
Chronic Achilles Tendonitis develops gradually over time. Many times, you can feel an obvious thickening of the tendon that may be tender when squeezed, due to long standing scarring of the tendon. Pain is also present when walking or during other forms of activity, and feels better at rest.
SYMPTOMS & DIAGNOSIS
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.
TREATMENT & SELF-HELP
Self-treatment should begin immediately after the injury, with a careful examination of the foot.
- Make sure that the tendon is not torn through and through. If it is severed, you must see a doctor immediately so that the tendon can be repaired. Severe injuries can sever a tendon, without a skin laceration being present. Testing involves moving the toes and foot to see if the tendon moves. If the tendon does not appear to move, it may be severed (comparing the injured tendon and its movement to the same tendon on the uninjured foot may help).Very sharp pain, a sudden pop, or an obvious gap in the structure of the tendon are all signs of a rupture, and should be seen by a doctor as soon as possible.
- If there is extreme swelling of the leg, and pain (out of proportion to the amount of trauma received), you may have sustained a vascular injury. A doctor must see this type of injury immediately. If you are not sure, see a doctor.
- If you have multiple injured areas see a doctor immediately, in order to prevent excessive swelling and pain. If the above exam is negative, then you may proceed with self-treatment. (However, if you are not sure of the extent of your injury, you should consult your doctor immediately).
- The sooner you begin to treat your injury by following “R.I.C.E.”, the better you will feel:
- Rest is very important. Take off your shoe, get off your feet, and relax.
- Ice should be applied as soon as possible. Never apply ice directly on the injured area, as the cold may make the pain worse. Ice should be applied close to the injured site, between the heart and the injury, so that as the blood flows under the ice, it will be cooled. This cool blood flowing into the injured area will help to reduce the swelling and pain. Apply the ice, wrapped in a cloth or over an elastic bandage, to the foot for 15 minutes, every 1-2 hours, for up to 3 days after an injury. If the ice is uncomfortable, or causes increased pain, do not continue to use it, and see a doctor. If you have poor circulation do not use ice, as this may cause a serious problem.
- Compression is used to limit swelling, and to give support to the injured area. Compression should be applied to the entire foot, starting first at the toes and working back to the ankle. If it is applied just to the injured area, increased swelling will occur in front and behind the wrapping. Compression should be applied with a 3-inch elastic bandage, beginning around the base of all the toes, and then going around the foot and ankle. Continue over the calf muscle when possible.Compression reduces motion in the injured area and foot, and this decreases the pain, and allows for quicker healing. The bandage should not be so tight that it causes increased pain or throbbing in the toes or foot. It should be comfortable! Do not remove the elastic bandage for the first 12 hours, unless it becomes too tight, or the pain increases, or the toes become pale, blue, or cool. If any of these things happen, immediately remove all bandages, and leave them off for several hours. The normal color and temperature of the toes should return immediately. If not, see a doctor immediately! Continue until the swelling and pain subsides; it could take from several days to several weeks.
- Elevation of the leg will aid in reducing swelling and pain. Blood rushes to an injured area to bring increased blood cells, that aid in healing. Gravity will also force blood to the injured area. Too many cells and too much fluid will apply pressure to the injured nerves and tissues, and cause increased pain and delayed healing. Keep your foot elevated so that it is at least parallel to the ground, or higher if it is comfortable. Do this for at least 48 hours, or until the throbbing subsides, when you lower the leg.
- Healing will occur more quickly if there is no pressure on the injured tendon, and if the foot is at least partially immobilized.
Arch supports (orthotics) are used to help cure chronic Achilles Tendonitis, and to prevent its recurrence. If your Achilles Tendonitis improves, but never completely subsides; or, if you have recurring episodes of Achilles Tendonitis, then you may benefit from custom-made orthotics. Certain biomechanical foot defects stress the Achilles Tendon by forcing it to twist as it crosses the ankle into the foot, rather than allowing it to run straight. The main causes of this pathologic twisting of the tendon are pronation or supination (the opposite of pronation). This twisting of the Achilles Tendon makes it weaker and more susceptible to over-utilization stresses and injuries, which causes the tendon to become inflamed and painful. Rigid and semi-rigid arch supports comfortably maintain the foot in its normal position, in relationship to the ankle and lower leg, thus preventing the foot from pronating or supinating. This allows the Achilles Tendon to run straight into the foot without twisting, allows the Achilles Tendonitis to disappear, and helps to prevent it from returning.
Night Splints are uniquely comfortable and effective in protecting the Achilles Tendon while sleeping. This splint gently prevents the foot from moving up and down at the ankle, thus immobilizing the Achilles Tendon and allowing it to heal. The Night Splint holds the foot in its normal or neutral position while we sleep, allowing healing to occur more quickly. This is not recommended if you suspect that the tendon may be torn, rather than inflamed.
The Achilles Heel Guard is used to relieve all pressure and friction from the back of the heel, and the lower portion of the Achilles Tendon, even when you are wearing a shoe. It also applies mild and comfortable compression to the tendon. This will reduce swelling and support the tendon, allowing it to heal more quickly. This product reduces pain and healing time. It prevents your shoe from irritating the painful area!
Fabrifoam Achilles Healer applies compression to the Achilles tendon helping to reduce stress and pain on the problem area. In addition, comfortable upward pressure is applied to the heel. The lift of the heel will reduce the stress and pain of the Achilles tendon. The Achilles Healer provides immediate relief from most Achilles Tendonitis related pain.
Removable Cast Boots limit the movement of the foot at the ankle, thus allowing the Achilles Tendon to rest and heal while you keep active and on your feet! Doctors frequently recommend the Ossur Equalizer Air Walker because of the added padding and comfort provided by its adjustable air chambers.