A tendon is a
band of connective tissue that anchors muscle to bone. The Achilles tendon is the largest tendon in the body. It attaches the calf muscles to the heel bone (calcaneus) and is very important because
it lets you lift your heel when you start to walk. It also helps you to walk, run or stand on tiptoe. Achilles tendonitis is inflammation of the Achilles tendon. In most cases, it is a type of
overuse injury and is more common in younger people. Professional and weekend athletes can suffer from Achilles tendonitis, but it is also a common overuse injury in people not involved in sport.
Treatment includes rest, non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy and avoiding activities that aggravate the condition.
Achilles tendonitis is aggravated by activities that repeatedly stress the tendon, causing inflammation. In some cases even prolonged periods of standing can cause symptoms. In many people who have
developed achilles tendonitis, chronic shortening of the gastroc-soleus muscle complex is the reason that home remedies and anti-inflammatory medications fail. In these instances the muscle itself
becomes shortened and creates a constant stress at the tendon?s attachment. Like a green branch that is slowly bent, eventually it begins to breakdown. Over a prolonged period the tendon becomes
inflamed, and in the worst cases, appears swollen and thickened. In certain circumstances attempts to heal have failed and the body?s inability to heal the tissue results in degenerative changes
known as achilles tendonosis. Anti-inflammatory medication, stretching and ice may only provide temporary relief, because they address the inflammation but not the root cause.
The symptoms associated with Achilles tendonitis and tendonosis include, Pain-aching, stiffness, soreness, or tenderness-within the tendon. This may occur anywhere along the tendon?s path, beginning
with the tendon?s attachment directly above the heel upward to the region just below the calf muscle. Often pain appears upon arising in the morning or after periods of rest, then improves somewhat
with motion but later worsens with increased activity. Tenderness, or sometimes intense pain, when the sides of the tendon are squeezed. There is less tenderness, however, when pressing directly on
the back of the tendon. When the disorder progresses to degeneration, the tendon may become enlarged and may develop nodules in the area where the tissue is damaged.
In diagnosing Achilles tendonitis or tendonosis, the surgeon will examine the patient?s foot and ankle and evaluate the range of motion and condition of the tendon. The extent of the condition can be
further assessed with x-rays or other imaging modalities.
To help heal your Achille?s Tendinitis, follow the R.I.C.E. Principle including Rest, Ice Compression and Elevation. In addition your physiotherapist will likely recommend specific exercises promote
healing and strengthening of the Achilles tendon and its supporting structures. As well an orthotic that elevates your heel can reduce stress on your Achilles tendon. Reducing inflammation in the
tendon is important too this can often be achieved with oral pills or topical creams. Over-the-counter pain medications or prescription strength such as ibuprofen. However, these drugs can have side
effects, like an increased risk of bleeding ulcers. They should be used only occasionally unless your doctor specifically says otherwise. Topical anti-inflammatory creams made with natural
ingredients designed specifically for feet and legs (eg ZAX?s Original Heelspur Cream ) target the affected areas and provides effective and safe relief. Tendinitis usually responds well to self-care
measures. But if your signs and symptoms are severe or persistent, your doctor might suggest other treatment options including surgery.
Percutaneous Achilles Tendon Surgery. During this procedure the surgeon will make 3 to 4 incisions (approx. 2.5 cm long) on both sides of the Achilles tendon. Small forceps are used to free the
tendon sheath (the soft tissue casing around your Achilles tendon) to make room for the surgeon to stitch/suture any tears. Skilled surgeons may perform a percutaneous achilles tendon surgery with
ultrasound imaging techniques to allow for blink suturing with stab incisions made by a surgical suture needle. This procedure can be done in 3 different ways depending on the preference and
experience of your surgeon. Instead of making several 2.5 cm incisions for this procedure, some surgeons will use guided imaging with an ultrasound to see the Achilles tendon tissue without having to
open up your ankle. For this technique, they will use a surgical needle to repeatedly stab your Achilles tendon. These "stab incisions" will allow the surgeon to "blindly" suture your tendon without
seeing the actual tissue. As another option - some surgeons will only make 1 to 3 incisions for smaller surgical implements to repair your tendon while relying on imaging ultrasound to see your
damaged tissue. During either procedure the use of ultrasound imaging or endoscopic techniques requires a very skilled surgeon.
A 2014 study looked at the effect of using foot orthotics on the Achilles tendon. The researchers found that running with foot orthotics resulted in a significant decrease in Achilles tendon load
compared to running without orthotics. This study indicates that foot orthoses may act to reduce the incidence of chronic Achilles tendon pathologies in runners by reducing stress on the Achilles
tendon1. Orthotics seem to reduce load on the Achilles tendon by reducing excessive pronation,