Achilles Tendonitis (tendinopathy)
What is achilles tendinopathy?
Achilles tendonopathy is a painful and often debilitating irritation of the Achilles tendon and supporting tissue. Of the achilles tendon injuries, this is more commonly seen in people over 40. The achilles tendon is an extension of the two main calf muscles and attaches to the heel bone(calcaneus). It seems most pain arising from the Achilles tendon is due to degenerative changes, or “wear and tear”, within the tendon itself. There may be some inflammation present in surrounding structures but not the tendon itself. For this reason the term tendinitis is no longer used when referring to tendons.
What causes achilles tendinopathy?
Usually the cause is overuse over a period of time. More commonly it results from an accumulation of smaller stresses that produce small tears in the tendon over time. In most cases, the appearance of symptoms are gradual. The discomfort may be relatively minor at first, but gradually worsens if the patient tries to ignore the pain.
Achilles tendon injuries are very frustrating as tendons have poor blood supply as other body tissues and are therefore slower to heal. Rest will probably allow the pain to settle but once you increase your activity level again the symptoms are likely to return. The balance between maintaining exercise and not reaggravating the condition is the key to recovery. Your biomechanics (the way your body parts move) need to be carefully assessed. Treatment may consist of specific stretches and very specific “eccentric” strengthening programmes that are closely supervised by your physiotherapist.
How does achilles tendinopathy feel?
Th typical Signs and Symptoms are increased pain during or after activity, tenderness to touch, possible thickening or swelling in comparison to the other side.
Management of achilles tendinopathy and how to fix it
The management of choice due to convincing medical evidence is an active rehabilitation program involving eccentric loading. This is when the tendon is being lengthened whilst under contractive load. The program is porgressive and must be specific to the return activities. In conjunction with this, the more conventional modalities listed below can also assist: Ice, heel raise wedges, soft tissue mobilisation as appropriate, examination of the foot mechanics, which may be causing an altered load on the tendon.
Sports Physicians and Orthopaedic surgeons can assist with the prescription of Nitrate patches which are used to reduce pain and speed up recovery.
Surgery is used as a last resort, followed by a very structured programme of rehabilitation.
Achilles Tendon Rupture
What is achilles tendon rupture?
This achilles tendon injury involves a complete tear of the achilles tendon. It is the most common of all complete tendon injuries seen in sports.
ref: Sports Injuries, Peterson and Renstrom, 1983
What causes achilles tendon rupture ?
Most cases of Achilles tendon rupture are traumatic sports injuries. It commonly occurs during explosive acceleration e.g. pushing off or jumping. The average age of patients is 30–40 years with males experiencing it at 10 times the rate of females. Fluoroquinolone antibiotics, such as ciprofloxacin and glucocorticoids have been linked with an increased risk of Achilles tendon rupture. Direct steroid injections into the tendon have also been linked to rupture.
How does achilles tendon rupture feel ?
The person describes feeling as if they were kicked in the back of the ankle. Often there is an audible snapping sensation. The person will have a limp and obvious weakness pushing off the toes.
Management of achilles tendon rupture and how to fix it
Surgical repair is the treatment of choice. It reduces the rate of re-rupture by 27% compared to non operative management. Following a period of immobilisation (usaually 6-8 weeks) an extensive rehabilitation program is essential to functional recovery.
Non surgical management is recommended in the elderly or patient with low levels of activity. The period of immobilisation is greater with this option and as mentioned the rate of re-rupture is increased.