tendon connects the calf muscle to the back of the heel. Injuries to the Achilles tendon are common, as it is in constant use during walking and running. These injuries, known as Achilles tendinitis,
are usually the result of overuse damage and minor tears that have accumulated over years. Your risk of developing Achilles tendinitis increases with age and activity level. Many athletes develop
Achilles tendinitis. The tendon may be injured several inches away from where it attaches to the foot or at the point of attachment. An injury at the point of attachment is called Achilles
enthesopathy. We recommend a combination of treatments over a period of months that may include wearing supportive shoes or orthotic devices, performing stretching exercises, and icing the affected
area. If these treatments are not effective, or if the tendon is completely torn, we may recommend surgery.
Possible factors leading to the development of Achilles tendonitis include the following. Implementing a new exercise regiment such as running uphill or climbing stairs. Change in exercise routine,
boosting intensity or increasing duration. Shoes worn during exercise lack support, either because the soles are worn out or poor shoe design. Omitting proper warm-up prior to strenuous exercise.
Running on a hard or uneven surface. Deformation in foot such as a flat arch, or any anatomic variation that puts unnecessary strain on the Achilles tendon.
Achilles tendonitis may be felt as a burning pain at the beginning of activity, which gets less during activity and then worsens following activity. The tendon may feel stiff first thing in the
morning or at the beginning of exercise. Achilles tendonitis usually causes pain, stiffness, and loss of strength in the affected area. The pain may get worse when you use your Achilles tendon. You
may have more pain and stiffness during the night or when you get up in the morning. The area may be tender, red, warm, or swollen if there is inflammation. You may notice a crunchy sound or feeling
when you use the tendon.
Physicians usually pinch your Achilles tendon with their fingers to test for swelling and pain. If the tendon itself is inflamed, your physician may be able to feel warmth and swelling around the
tissue, or, in chronic cases, lumps of scar tissue. You will probably be asked to walk around the exam room so your physician can examine your stride. To check for complete rupture of the tendon,
your physician may perform the Thompson test. Your physician squeezes your calf; if your Achilles is not torn, the foot will point downward. If your Achilles is torn, the foot will remain in the same
position. Should your physician require a closer look, these imaging tests may be performed. X-rays taken from different angles may be used to rule out other problems, such as ankle fractures. MRI
(magnetic resonance imaging) uses magnetic waves to create pictures of your ankle that let physicians more clearly look at the tendons surrounding your ankle joint.
Wear shoes with a low half-inch to one-inch heel that are somewhat flexible through the ball of the foot. Avoid flat footwear such as slippers or sandals and stiff shoes. Add a heel lift in your
shoe. You may also use arch support inserts or orthotic insoles. Heel lifts and orthotics can be purchased at many of our pharmacies and Podiatry departments. Avoid standing or walking barefoot.
Perform calf-stretching exercises for 30 to 60 seconds on each leg at least 2 times a day. Stand an arm?s length away from a wall, facing the wall. Lean into the wall, stepping forward with one leg,
leaving the other stretched behind you. The leg behind you is the one being stretched. Keep this leg straight (locked) and the toes pointed straight at the wall. Stretch forward until you feel
tightness in the calf of your back leg. Hold this position without bouncing for 30 to 60 seconds. Repeat for the opposite leg. Do stair exercises every day. Stand facing the stairs with the ball of
your foot on a stair and your heel hanging off. Balance on one foot at a time while holding onto the rail. Slowly lower your heel as low as it will drop down and then slowly raise it up as high as
you can lift it. Repeat this exercise slowly several times on each foot. Perform this exercise every other day, gradually increasing the number of repetitions over time as tolerated. If you are
overweight, talk to your personal physician about resources that can help you lose weight. Carrying excess weight places additional pressure on your feet. Decrease the time that you stand, walk, or
engage in exercises that put a load on your feet. Switch to a nonimpact form of exercise until your tendon heals, such as swimming, pool running, and using an elliptical trainer.
Most people will improve with simple measures or physiotherapy. A small number continue to have major problems which interfere with their lifestyle. In this situation an operation may be considered.
If an operation is being considered, the surgeon will interview you and examine you again and may want you to have further treatment before making a decision about an operation. Before undergoing
Achilles tendonitis surgery, London based patients, and those who can travel, will be advised to undergo a scan, which will reveal whether there is a problem in the tendon which can be corrected by
surgery. Patients will also have the opportunity to ask any questions and raise any concerns that they may have, so that they can proceed with the treatment with peace of mind.
Suggestions to reduce your risk of Achilles tendonitis include, icorporate stretching into your warm-up and cool-down routines. Maintaining an adequate level of fitness for your sport. Avoid dramatic
increases in sports training. If you experience pain in your Achilles tendon, rest the area. Trying to ?work through? the pain will only make your injury worse. Wear good quality supportive shoes
appropriate to your sport. If there is foot deformity or flattening, obtain orthoses. Avoid wearing high heels on a regular basis. Maintaining your foot in a ?tiptoe? position shortens your calf
muscles and reduces the flexibility of your Achilles tendon. An inflexible Achilles tendon is more susceptible to injury. Maintain a normal healthy weight.