Treatment Of Achilles Tendinitis Discomfort

Overview

Achilles TendonThe Achilles tendon is the largest and strongest tendon in the human body. It is the ?cord? in the back of the leg that inserts into the back of the heel. The Achilles tendon got its name, according to Greek legend, when the Greek warrior, Achilles, was dipped into the River Styx by Thetis, his mother. This rendered him invincible with the exception of his unsubmerged heel. Unfortunately, he went on to get mortally wounded during the siege of Troy when he was struck in that heel by an arrow. Achilles tendinitis is inflammation and partial tearing of the Achilles tendon. It can occur with overuse of the tendon such as when starting or increasing the intensity of an exercise program or performing impact loading activities that include a lot of running and/or jumping.

Causes

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of many tiny tears to the tendon that have happened over time. Health professionals may use different terms to describe a tendon injury. You may hear, Tendonitis (or Tendinitis): This actually means "inflammation of the tendon," but inflammation is rarely the cause of your tendon pain.

Symptoms

Achilles tendonitis is an injury that occurs when your Achilles tendon -- the large band of tissues connecting the muscles in the back of your lower leg to your heel bone -- becomes inflamed or irritated. The signs and symptoms of Achilles tendonitis often develop gradually. You'll feel pain and stiffness in your Achilles, especially when you first get out of bed. The pain lessens as you warm up, and may even disappear as you continue running. Once you stop, the pain returns and may feel even worse. You may also notice a crackling or creaking sound when you touch or move your Achilles tendon.

Diagnosis

During an examination of the foot and ankle, you doctor will look for the following signs, Achilles tendon swelling or thickening. Bone spurs appearing at the lower part of the tendon at the back of the hell. Pain at the middle or lower area of the Achilles tendon. Limited range of motion of the foot and ankle, and a decreased ability to flex the foot. Your doctor may perform imaging tests, such as X-rays and MRI scans, to make a diagnosis of Achilles tendinitis. X-rays show images of the bones and can help the physician to determine if the Achilles tendon has become hardened, which indicated insertional Achilles tendinitis. MRI scans may not be necessary, but they are important guides if you are recommended to have surgical treatment. An MRI can show the severity of the damage and determine what kind of procedure would be best to address the condition.

Nonsurgical Treatment

If caught early enough, simple physical therapy that you can do by yourself should be fine. Over the counter solutions as easy as pain medication, cold compresses, a different pair of shoes, or a new set of stretching exercises can make most of the symptoms of Achilles tendinitis disappear. Further trouble or extreme pain should be regarded as a sign that something more serious is wrong, and you should immediately consult a doctor or physician. They will look to see whether non-surgical or surgical methods are your best options, and from there you can determine what your budget is for dealing with the condition.

Achilles Tendonitis

Surgical Treatment

Surgery should be considered to relieve Achilles tendinitis only if the pain does not improve after 6 months of nonsurgical treatment. The specific type of surgery depends on the location of the tendinitis and the amount of damage to the tendon. Gastrocnemius recession. This is a surgical lengthening of the calf (gastrocnemius) muscles. Because tight calf muscles place increased stress on the Achilles tendon, this procedure is useful for patients who still have difficulty flexing their feet, despite consistent stretching. In gastrocnemius recession, one of the two muscles that make up the calf is lengthened to increase the motion of the ankle. The procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope-an instrument that contains a small camera. Your doctor will discuss the procedure that best meets your needs. Complication rates for gastrocnemius recession are low, but can include nerve damage. Gastrocnemius recession can be performed with or without d?bridement, which is removal of damaged tissue. D?bridement and repair (tendon has less than 50% damage). The goal of this operation is to remove the damaged part of the Achilles tendon. Once the unhealthy portion of the tendon has been removed, the remaining tendon is repaired with sutures, or stitches to complete the repair. In insertional tendinitis, the bone spur is also removed. Repair of the tendon in these instances may require the use of metal or plastic anchors to help hold the Achilles tendon to the heel bone, where it attaches. After d?bridement and repair, most patients are allowed to walk in a removable boot or cast within 2 weeks, although this period depends upon the amount of damage to the tendon. D?bridement with tendon transfer (tendon has greater than 50% damage). In cases where more than 50% of the Achilles tendon is not healthy and requires removal, the remaining portion of the tendon is not strong enough to function alone. To prevent the remaining tendon from rupturing with activity, an Achilles tendon transfer is performed. The tendon that helps the big toe point down is moved to the heel bone to add strength to the damaged tendon. Although this sounds severe, the big toe will still be able to move, and most patients will not notice a change in the way they walk or run. Depending on the extent of damage to the tendon, some patients may not be able to return to competitive sports or running. Recovery. Most patients have good results from surgery. The main factor in surgical recovery is the amount of damage to the tendon. The greater the amount of tendon involved, the longer the recovery period, and the less likely a patient will be able to return to sports activity. Physical therapy is an important part of recovery. Many patients require 12 months of rehabilitation before they are pain-free.

Prevention

Your podiatrist will work with you to decrease your chances of re-developing tendinitis. He or she may create custom orthotics to help control the motion of your feet. He or she may also recommend certain stretches or exercises to increase the tendon's elasticity and strengthen the muscles attached to the tendon. Gradually increasing your activity level with an appropriate training schedule-building up to a 5K run, for instance, instead of simply tackling the whole course the first day-can also help prevent tendinitis.

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