ORTHOPEDICS/LEG, FOOT & ANKLE/TREATMENT & SURGERY
Achilles tendon pain
The Achilles tendon is the principal tendon in the body.
The Achilles tendon joins the gastrocnemius (calf) and the soleus lower leg muscles to the heel foot bone.
Achilles tendon is very strong, but not very elastic.
This means that the Achilles tendon can only stretch so far before becoming inflamed (known as tendonitis).
A conceded Achilles tendon can cause soreness, stiffness to serious pain.
Achilles tendon pain reasons
You should be familiar with the different disorders that affect the Achilles tendon, considering that they need unique attention and therapy.
The two most common reasons of Achilles tendon pain are Achilles tendonitis and Achilles tendonosis.
The first is acute and the second is chronic.
- Achilles Tendonitis
Achilles tendonitis is an acute, inflammatory damage of the Achilles tendon that most commonly affects athletes (Sprinter, tennis…)
Achilles tendonitis cause sever pain that worsens with movement.
The location of the pain may vary: it can be felt closer to the bottom of the calf muscle, along the actual tendon, or lower down near the heel bone.
In addition, Achilles tendon may cause mild inflammation and warmth.
Performing sports activity with inadequate shoes can also cause Achilles tendonitis.
Having a medical disorder like psoriasis, high blood pressure, and obesity has also been related to a higher risk for developing Achilles tendonitis.
- Achilles Tendonosis
Different from the Achilles tendonitis, Achilles tendonosis describes a chronic, degenerating tendon that results from untreated tendonitis.
With Achilles tendonosis, the collagen fibers that make up the tendon weaken or even break down.
The complicated part is that while the inflammation of Achilles tendonitis can ease up with appropriate therapy, some conditions are not accompanied by pain; in these conditions tendonosis does not appear developed until pain feeling.
Achilles Tendon Rupture
As said before, the Achilles tendon is the strongest tendon in the body; therefore it is difficult and rare that this tendon ruptures.
However, when a sudden force is exerted on the tendon, such as sudden pivoting of the foot in playing basketball, or a sudden step off a curb can occasionally be enough to overstretch and tear the tendon.
Generally, with a Achilles tendon rupture, a person cannot walk or bear weight on their foot.
When to See a Doctor
Medical attention is recommended if you develop pain in the back of your leg.
Other signs that recommend a doctor’s visit include:
- Leg or ankle toughness or discomfort
- Inflammation over the Achilles tendon
- Difficulty in standing on your sneaks
- Redness or warmth around the ankle
Diagnosis
The diagnosis of Achilles tendon pain is generally performed clinically.
If a rupture is suspected, imaging with magnetic resonance imaging (MRI) or ultrasound is important.
Physical Inspection
A detailed physical foot and ankle exam is the key to diagnosing the reason behind the Achilles tendon pain.
A doctor can occasionally diagnose an Achilles tendon rupture by palpating the tendon.
Another physical exam clue for an Achilles tendon rupture is staining over the tendon, specifically if the blood travels beneath the malleolus (the bone that projects out on each ankle).
Thompson Test
Including the physical exam for Achilles tendon pain, the specialist will perform the Thompson test, also called the “calf squeeze test”.
During this test, a person lies flat on the exam table with his or her feet hanging over the edge. The doctor will then squeeze on the calf muscle, which should flex the toes downward (called plantar flexion).
If this does not happen, the test is positive for an Achilles tendon rupture.
Imaging
Imaging of the ankle is not generally needed to diagnose Achilles tendon difficulties; an ultrasound of the Achilles tendon may be used to access for tendon thickening (as seen in Achilles tendonosis).
An ultrasound or an MRI is used to confirm a diagnosis of an Achilles tendon rupture.
Diagnosis
Some common conditions of Achilles tendon rupture include:
A twisting ankle, crack tension, or heel bursitis (called calcaneal bursitis).
An X-ray is recommended to distinguish among these conditions.
With calcaneal bursitis, there is frequently palpable tenderness where the tendon inserts into the heel bone.
On the other hand, with Achilles tendonitis, the tendon pain is generally higher up (about two to six centimeters above the insertion site).
Other conditions
- Osteoarthritis
Inflammatory arthritis (for example, rheumatoid arthritis or gout)
- Fibromyalgia
Blood clot in the calf (called deep venous thrombosis)
- Inflammation (for example, osteomyelitis or cellulitis)
- Bone tumor or cancer (rare)
In these above examples, along with a detailed physical exam, blood tests or imaging tests, like an ultrasound or X-ray, may be performed to confirm a diagnosis.
Similarly, with rheumatoid arthritis, a person will frequently have an elevated anti-cyclic citrullinated peptide (anti-CCP) blood level, along with other signs of RA like fatigue and joint pain.
Therapy
There are various therapy involved with treating Achilles tendon pain, including activity change, medicine, physical therapy, and probably, surgery.
Self-Care
Self-care approaches can be used to treat Achilles tendonitis
Decrease Activity or Relax
With Achilles tendonitis, it is not essential to stop activity entirely.
Start gentle calf stretching after exercise when the muscle and tendon are still warm and flexible.
Note that relaxation is imperative for the initial care of an Achilles tendon rupture..
Ice
For Achilles tendonitis, applying ice during the initial onset of pain, along with post-exercise, ice may be supportive.
With a sudden rupture, apply ice directly on the tendon and go straight to the nearest emergency point.
Support
When suffering Achilles tendonitis, besides decreasing activity and applying ice, keeping your tendon from moving around by covering your ankle with an elastic bandage is significant.
Similarly, an orthopedic surgeon will block the ankle, repeatedly with a bandage, until undergoing surgery for an Achilles tendon rupture.
Medicine
To decrease the pain from any Achilles tendon difficulty, a nonsteroidal anti-inflammatory is occasionally taken. While a common misconception, corticosteroid injections are not recommended for Achilles tendon pain.
Physical Therapy
To strengthen the calf muscle after an Achilles tendon rupture, some exercises are advised: Toe raises, balancing toes, and wall stretching exercises.
Strength training is also beneficial therapy alternative.
Instrument-assisted soft tissue mobilization (IASTM) is a motivating modality sometimes used in the therapy of Achilles tendonosis.
This therapy works by using an instrument to re-stimulate the body’s inflammatory process that activates the development of new collagen within the tendon.
Surgery
An Achilles tendon rupture most often requires surgical restoration by an orthopedic surgeon within one to two days of the damage.
This surgery consist in binding the two ends of the separated tendon in order to suture together.
Anticipation
The biggest reason of an Achilles tendon difficulty is ignoring early warning indications and pushing through the pain.
When Achilles’s tendon is sore or aches, relaxation is required immediately.
Stretching
Do not forget stretching and warming before any activity to avoid an Achilles tendon damage.
Few fundamental stretches include:
Achilles tendon stretch
Calf stretch
Allow a proper warm-up.
Strengthening
Strengthening of the Achilles tendon, gastrocnemius, and soleus muscles may diminish the risk of Achilles tendonitis and calf tension.
Other tips
Other tips that may help preventing an Achilles tendinitis include:
- Always wear shoes that provide adequate arch support
- Avoid running on hard surfaces
- Avoid practicing exercises or sports activities outside in cold weather
A final word
Achilles tendon pain is a common disorder.
With correct therapy, the majority of people may recover.
Even if the disorder becomes chronic, a fine rehabilitation program allows getting back track.