• Achilles Tendinopathy

    (Achilles Tendonitis; Achilles Tendinosis)

    Definition

    Tendons connect muscle to bone and often connect near a joint. Tendinopathy is an injury to the tendon. It can cause pain and swelling and makes it difficult to move. Tendinopathy may be:
    • Tendonitis—inflammation of the tendon. (less common)
    • Tendinosis—tiny tears in the tendon with no significant inflammation. (more common)
    The achilles tendon connects the calf muscle to the heel bone.
    Achilles Tendonitis
    Achilles Tendonitis
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Tendinopathy is generally caused by overuse of a muscle-tendon unit. Over time, the strain on the tendon causes structural changes within the tendon itself.
    Overuse of the Achilles tendon can occur with activities such as:
    • Increasing your speed or running long distances too quickly
    • Suddenly adding strenuous hills or stair climbing to your exercise routine
    • Doing too much too soon after taking time away from exercising
    • A sudden or violent contraction of the calf muscles, such as during an all-out sprint
    • Running too much (overuse)
    • Lack of flexibility of the calf muscles

    Risk Factors

    Factors that increase your chance of Achilles tendinopathy include:
    • Improper or badly worn footwear
    • Improper warm-up for your activity
    • Inflexibility of the calf muscles
    • Improper cool-down
    • An improper training program—such as increasing intensity too quickly
    • Increasing age—normal wear and tear can make the tendon more vulnerable to injury

    Symptoms

    Tendinopathy may cause:
    • Tenderness—usually just above the heel bone and often more noticeable in the morning
    • Stiffness that gradually eases as the tendon is warmed-up
    • Pain after activity that gradually worsens
    • Radiating or localized pain along the tendon during and/or after running
    • Swelling in the area of the achilles
    • Pain at the back of the ankle

    Diagnosis

    The doctor will ask about your symptoms and exercise habits. A physical exam will be done. Your doctor will likely make a diagnosis based on the exam and history.
    Further test may be ordered if the injury is severe or is not healing as expected. Images of the bones and tendons may be taken with:

    Treatment

    Tendinopathy and the associated pain may take months to resolve. It can be frustrating but it is important to follow through with recommended treatment.

    Rest and Ice

    Rest and ice are the first steps. Take a break from any activity that causes pain. Switch to activities that doesn't put stress on the tendon. Avoid uphill and irregular surfaces. Swimming is a good option. Once the pain has gone, gradually increase your activity levels.
    Place ice or an ice pack on the area for 20 minutes at a time. This can help the first few days after the injury. It may also help after activity, if you have activity related pain.

    Foot and Ankle Support

    You may be advised to wear a shoe insert. It will place your foot in the correct position for walking and running.
    Taping your ankle during activity may also help. Talk to your doctor or a physical therapist before using this option. They can show you the proper way to wrap your foot.

    Physical Therapy

    More severe or recurring injuries may need physical therapy. Therapy may include:

    Medications

    The doctor may recommend medication to help reduce swelling and pain. Medication options include:
    • Nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain (eg, aspirin or ibuprofen )
    • Topical pain medicines (eg, cream, patches) that are applied to the skin
    If you are diagnosed with this condition, follow your doctor's instructions .
    If you are diagnosed with this condition, follow your doctor's instructions .

    Prevention

    To decrease your chances of getting achilles tendonitis:
    • Take the time to warm-up and cool-down properly.
    • Wear appropriate footwear for your sport.
    • Do not use shoes beyond the recommended duration. This will depend on:
      • How frequently you exercise
      • The surface on which you exercise
      • The conditions in which you exercise
    • Gradually add hill work, stairs, speed, and distance to your routine.
    • Stretch and strengthen the calf muscles regularly.

    RESOURCES

    American Academy of Orthopaedic Surgeons http://www.aaos.org/

    American Orthopaedic Society for Sports Medicine http://www.sportsmed.org/

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org/

    Canadian Orthopaedic Foundation http://www.canorth.org/

    References

    Achilles tendinopathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated October 23 2012. Accessed December 28, 2012.

    Achilles tendinopathy. American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00147 . Accessed December 28, 2012.

    de Jonge S, van den Berg C, de Vos RJ, et al. Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med . 2011;45(13):1026-1028.

    Irwin TA. Current concepts review: insertional achilles tendinopathy. Foot Ankle Int . 2010;31(10):933-939.

    10/26/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

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