Achilles

Achilles

Achilles tendinitis (correctly named Achilles tendinopathy) is a medical condition characterized by the inflammation and irritation of the Achilles tendon that can occur either in the acute or chronic form.

The condition derives its name from Greek mythology, named after Achilles, the invincible Greek warrior of the Trojan War, who was considered to be vulnerable only at his heel.

The Achilles tendon is a large rope-like band of fibrous tissue that connects the large calf muscles (Gastrocnemius and Soleus) to the heel bone (calcaneus). It is the largest and the most frequently ruptured tendon in the human body.

Research indicates that Achilles tendonitis accounts for around 11% of all running injuries. In US, Achilles tendonitis is known to inflict over 230,000 patients every year.

If left untreated, Achilles tendinitis can make the patient vulnerable to the risk of the Achilles tendon rupture.

Key Symptoms

The pain associated with Achilles tendinitis is often described as a dull to shooting pain, burning pain or even an extremely piercing pain.

The most common pattern of symptoms reported in the case of Achilles tendinitis includes:

  • Pain anywhere along the back of the tendon, but usually close to the heel
  • Mild pain after exercise or running that gradually worsens
  • Swelling or thickening around the tendon
  • Limited ankle flexibility
  • Tenderness in the morning, about an inch above the point where the Achilles tendon is attached to the heel bone
  • Redness or heat over painful area
  • Stiffness that generally disappears as the tendon warms up with use
  • Appearance of a lumpy build-up of scar tissue (nodule) on the tendon
  • Cracking sound with ankle movement

It should be noted that since a partial tendon tear and heel bursitis have similar symptoms, an orthopedic surgeon must be contacted for a proper diagnosis.

Causative Factors

An athlete or a runner may experience an attack of Achilles tendinitis due to a varied set of reasons. Here we list the main events or causes that might trigger of an episode of the condition:

Rapid increase in the running mileage or speed

  • Adding hill running or stair climbing to the training routine
  • Tight or fatigued calf muscles, which further transfer the burden of running to the Achilles tendon
  • Trauma caused by a sudden or hard contraction of the calf muscle, when over-exerting, such as in a final sprint
  • Overuse, as a result of a natural lack of flexibility in the calf muscles
  • Medication side-effects
  • Change of footwear, often changing to ‘barefoot or minimalistic’ type trainers
  • Over pronation is also considered to be a leading cause of Achilles tendinitis. It is a practice where the athlete rotates the feet too far inwards on impact.

Prevention

  • Choose your running shoes carefully.
  • Walk and stretch to warm up gradually before running
  • Focus on stretching and strengthening the calf muscles
  • Increase your running distance and speed at a maximum of 10% a week
  • Avoid unaccustomed strenuous sprinting and hill running
  • Follow a proper regimen for cooling down

Treatment Modalities

Non-steroidal anti-inflammatory medication (NSAIDs).

  • You may also have to use Orthoses, which are devices that are meant to provide support to the muscle and relieve stress to the tendon, for instance, heel pad, heel cup, heel cradle or shoe insert.
  • In some cases, a bandage specifically designed to restrict motion of the tendon proves helpful.
  • Physical therapy, such as HVGS (electrical stimulation) may also be advised .

Since the Achilles tendon has a poor blood supply, the healing process is rendered quite slow.

Surgical Intervention

Surgery is considered as a last resort in the case of Achilles tendinitis. It is regarded as an option when the friction between the tendon and its covering sheath makes the sheath thick and fibrous.

In such cases, surgery is planned to remove the fibrous tissue and repair any tears. However, recovery after such procedures might be slow. The patient may also have to wear a temporary cast and follow a rehabilitation program to avoid weakness.

Self Care

There are several measures you need to take as a runner to prevent the recurrence of Achilles tendinitis. Here we list the main amongst them:

Take a break from your running schedule till you can do heel raises and jumping exercises comfortably

  • Follow ice-therapy. Apply ice to the Achilles for 10 minutes every 2 hours, which will help in reducing inflammation
  • Avoid any weight-bearing exercises
  • Keep the foot elevated wherever possible
  • Self-massage with arnica oil or an anti-inflammatory gel, rubbing in semi-circles in all directions away from the knotted tissue, thrice a day, till the nodule disappears
  • Do gentle stretching exercises using the calf muscle
  • Try swimming, pool running or low-gear cycling as alternate exercises