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Achilles Tendinitis

Achilles tendinitis is inflammation of the Achilles (uh-KIL-eez) tendon, the group of tissue that links leg muscles at the back of the bottom leg to your heel bone.

Achilles tendinitis is usually a running injury or other sport-related trauma resulting from too much use, intensive activity, bouncing, or other actions that will strain the tendon and leg muscles.

Many cases of Achilles tendinitis is treatable with the help of persistent, relatively simple, at-home treatment under your doctor's guidance. Self-care techniques usually are needed to avoid repeated symptoms.

Serious incidents of Achilles tendinitis can lead to tendon tears (ruptures) and may even need surgery to fix broken tissues.

Symptoms

The most common indication associated with Achilles tendinitis is normally ache which increases eventually and worsens over time. Symptoms of Achilles tendinitis include things like:

Minor pain or pain at the back of the leg as well as above the heel right after running or some other sports activity

Installments of more serious discomfort associated with prolonged running, stair ascending or intense exercise, including sprinting

Tenderness or stiffness, particularly in the morning, that always improves with slight movement

Moderate inflammation or possibly a "bump" on your Achilles tendon

A crackling or creaking sound when you touch or move your Achilles tendon

A weakness or possibly sluggishness in your lower leg

When to visit a health practitioner

Should you experience pain around an Achilles tendon or heel, contact your doctor. The discomfort may be caused by Achilles tendinitis, inflammation of other close by tissue or other tissue damage. As a result, it's important to have a prompt diagnosis and proper treatment.

While awaiting a consultation, you could ease pain aided by the following measures:

Participate in much less intense training

Have a break from your physical activity routine

Set an ice pack over the affected region after training or when you feel pain

Take an over-the-counter nonsteroidal anti-inflammatory medicine, such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others), as directed on the content label

Find prompt attention if the soreness or impairment is severe.

You could have a ripped, or ruptured, Achilles tendon if you:

Experience unexpected, extreme pain

Cannot bend your foot downward or walk on your toes on the damaged part

Are not able to place weight on your foot or walk normally

Causes

Achilles tendinitis, or inflammation of the tendon, can be caused by repetitive or intense strain on the tendon.

The Achilles tendon is a major band of tissue connecting the muscles at the back of your lower leg to your heel bone. Also known as the heel cord, the Achilles tendon is used when you walk, run, jump or push up on your toes.

Numerous reasons may lead to the onset of Achilles tendinitis:

A rapid rise in the distance or acceleration of a running routine

New or extreme mountain running or stair ascending

Sports activities that need leaps or rapid starts and stops, such as basketball or tennis

Exercising without warm up

A different, extreme exercise routine following a long period of not exercising regularly

Poor overall flexibility in the calf muscles

Running on irregular or challenging areas

Wearing footwear that are worn-out or inappropriate for the training

A naturally flat arch, which can put more tension on the Achilles tendon

Some other small variations in the foot, ankle or leg anatomy that may put extra stress on the tendon

Traumatic accident to the tendon

Complications

Achilles tendinitis can progress to a degenerative condition called Achilles tendinosis. This alteration of the arrangement of the tendon weakens it and causes it to be more susceptible to serious harm. Weakening of the Achilles tendon can lead to a tear, or rupture, which is a painful injury that usually requires surgical treatment to repair the affected tendon.

Preparing for your consultation

If you're going through pain and other indications that may be a result of Achilles tendinitis, you'll likely begin by seeing your family physician or general practitioner. You may be referred to a physician specializing in sports medicine or a professional in disorders of bones, tendons and joints (orthopedist) or a specialist in physical and rehabilitative treatments (physiatrist).

What you should expect from your physician

Be ready to answer the following questions on your symptoms and factors that may be triggering your problem:

When did pain or other signs start?

Are symptoms more intense at times of day or after certain routines?

Does the pain diminish with relaxation?

What is your usual training session?

Have you recently made changes to your training session, or have you just lately started participating in a different game?

What have you done to alleviate soreness?

What type of shoes or boots do you wear for several activities?

Questions you can make to ask your doctor include the following:

What is likely causing the discomfort?

What are my treatment options?

How much time is treatment gonna take?

How much will I need to limit my existing activity level or adjust my exercise routine?

When do I need to see you for a follow-up appointment?

Tests and diagnosis

An analysis of Achilles tendinitis is based on your answers to questions, results of a physical check-up and, if required, imaging tests.

Examination

Your doctor is going to carefully touch (palpate) the affected area to look for the location of pain, tenderness or swelling. He or she will likely assess the flexibility, position, range of motion and reflexes of your foot and ankle.

Imaging testing

Imaging testing will help eliminate other factors that cause symptoms and uncover harm to the tendon. Your doctor may order one or more of the following testing:

X-ray, which produces images of hard tissues, can help eliminate other causes of symptoms.

Ultrasound, an image of soft tissues created by using sound waves, can show you signs of inflammation and injury to the Achilles tendon. The pictures also can generate live-action photographs of the tendon in motion.

Magnetic resonance imaging (MRI), which uses a magnetic field and radio waves to generate cross-sectional views or 3-D images, can display details about tissue degeneration and tendon ruptures.

Remedies and drug treatments

Tendinitis is usually treated with relatively basic interventions, but successful treatment demands patience and cautious adherence to remedy instructions. Your physician will probably recommend a combination of interventions for Achilles tendinitis:

Self-care techniques

Pain medicines

Stretching and exercises

Self-care methods

Self-care includes the following ways, often known by the acronym R.I.C.E.:

Rest. Rest is crucial for tissue healing. Based on the severity of your problems, resting may mean not working out for a few days; reducing the duration and intensity of your routine; or switching to an activity that doesn't pressure the Achilles tendon, like swimming. You may need to put on a walking boot and use crutches if you have major ache when putting weight on your foot. Your doctor can tell you on what type of rest is appropriate for you.

Ice. To decrease pain or swelling, apply an ice pack to the tendon for about fifteen minutes after working out or whenever you experience pain.

Compression. Wraps or compressive flexible bandages will help lower swelling and lower movement of the tendon.

Elevation. Raise the affected foot above the level of your heart to reduce swelling. Sleep with your affected foot elevated at night.

Pain medication

Your doctor will probably suggest a prescription-strength or over-the-counter nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others) to eliminate inflammation and reduce pain.

Long-term use of NSAIDs could cause stomach pain, stomach bleeding, ulcers and other negative effects. Talk to your physician about how long you must take your medication and how he or she will monitor you for negative effects.

Stretching and exercising

Appropriate stretching and training can promote recovery and prevent recurring problems. Your doctor can show the right method or refer you to a physical therapist or professional in sports medicine. These approaches include:

Stretching with knees straight. Lean towards a wall with your knees straight and heels on the floor to stretch the upper portion of calf muscles.

Stretching with knees bent. Position the foot forward and flex the knee and ankle using the heel flat on the floor to extend the lower part of calf muscles.

Working out calf muscles. Toe raises or the use of a calf-strengthening machine can help make the tendon tougher and treat Achilles tendon complications. A special type of strengthening called "eccentric" conditioning has been shown to be particularly effective in treating serious tendon problems. An example of this type of exercise to strengthen the calf muscle is gradually descending to the ground after rising on your toes.

Alternative solutions

Additional solutions may include these:

Orthotic devices guard or change the position of the foot and ankle to be able to promote healing. A footwear insert or wedge that slightly elevates your heel can alleviate strain on the tendon and offer a cushion that reduces the amount of force exerted on the tendon.

Corticosteroid shots may be used with caution to lessen inflammation around a tendon that's been chronically swollen. A greater risk of tendon rupture has been observed with this treatment. To reduce that risk, your doctor may use ultrasound imaging to ensure that he or she injects the corticosteroid close to the target site while steering clear of a direct shot into the tendon.

Platelet rich plasma (PRP) injection is a quite recent procedure under research for treating chronic, nonhealing destruction of the Achilles tendon (Achilles tendinosis) and other persistent tendon problems. This therapy requires injecting your own blood plasma, which contains factors that increase recovery, at the site of the inflamed tendon.

Surgery to repair damaged tissue and improve function of the tendon is considered only if several months of more conservative treatments don't work or if ongoing inflammation leads to partial or complete rupture of the tendon.

Prevention

While it may not be possible to avoid Achilles tendinitis, you can take actions to reduce your risk:

Improve your activity level gradually. If you're just starting a workout regimen, start slowly and gradually raise the period and intensity of the training.

Take it easy. Stay away from routines that place excessive stress on your tendons, such as hill running. If you take part in a strenuous recreation, warm up first by exercising at a slower pace. If you notice pain during a certain exercise, stop and rest.

Choose your shoes carefully. The footwear you put on while exercising should provide adequate cushion for your heel and should have a firm arch support to help reduce the strain in the Achilles tendon. Replace shoes that show excessive wear. In case your footwear are in good condition but do not support your feet, try arch supports in both shoes.

Stretch out daily. Take the time to stretch your calf muscles and Achilles tendon each morning, prior to exercise and after exercise to keep flexibility. This is especially important to avoid a recurrence of Achilles tendinitis.

Strengthen your calf muscles. Sturdy calf muscles enable the calf and Achilles tendon to better deal with the tensions they encounter with activity and exercise.

Cross-train. Alternate high-impact activities, such as running and jumping, with low-impact routines, such as cycling and swimming.

Lifestyle and home cures

If you believe you have Achilles tendinitis, help speed your recovery and prevent further problems by trying these at-home care methods:

Rest. Avoid routines that increase the pain or swelling. Don't try to work or play through the soreness. Rest is vital to tissue healing. But it doesn't mean full bed rest. You can do alternative activities and exercises that don't stress the injured tendon, particularly low-impact routines, like bicycling.

Ice. To decrease pain, muscle spasm and swelling, apply ice to the injured area for up to twenty minutes, many times a day. Ice packs, ice massage or ice water slush baths all might help. For an ice massage, freeze a plastic foam cup full of water to enable you to hold the cup while putting on the ice on to your skin.

Compression. Because swelling can result in loss of movement in an injured joint, compress the area until the swelling has ceased. Wraps or compressive elastic bandages are ideal.

Elevation. Raise the affected ankle above the level of your heart to minimize swelling. It is particularly significant to use this position at night.

Keep moving

Despite the fact that rest is a major factor of treating tendinitis, prolonged lack of exercise could cause stiffness in your joints. Move the injured ankle through its full range of motion and perform delicate Achilles tendon stretches to maintain joint flexibility.

Phototherapy. Deep penetrating phototherapy provides excellent pain relief without the side effects caused by anti-inflamatory medications.  Phototherapy speeds up the healing time of injured tendons.

Anti-inflammatory treatments

You can also try nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen (Advil, Motrin, others) or products containing acetaminophen (Tylenol, others) to try to reduce the discomfort associated with tendinitis.

Be sure to talk to your physician if you feel you need NSAIDs for an prolonged time because some of these medicines should be used for only limited periods - close to 7 to 10 days - to prevent complications.

If you take NSAIDs frequently or take more than the advised dosage, these drugs could cause stomach pain, stomach bleeding and ulcers. Rarely, extended use can affect normal kidney function. If you have liver problems, speak to your physician before using products containing acetaminophen.