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Achilles Tendonitis
Achilles tendonitis is a condition characterised by inflammation of the Achilles tendon, which connects the calf muscles to the heel bone. It is common among athletes and people who engage in activities that place significant stress on the tendon. Achilles tendonitis can cause pain, stiffness, and swelling, impacting daily activities and athletic performance.
Experiencing pain, stiffness, or swelling in your achilles tendon area? Consult our achilles tendon specialist today for an accurate diagnosis & personalised treatment plan.
Dr Dennis Ng Zhaowen
Causes of Achilles Tendonitis
Achilles tendonitis can result from a variety of factors, primarily related to overuse and strain on the Achilles tendon. Common causes include:
- Overuse Frequent, intense physical activities such as running, jumping, and rapid directional changes can lead to overuse of the Achilles tendon. This is particularly common in athletes who increase their activity level suddenly without adequate preparation or conditioning.
- Wearing Improper Footwear Wearing shoes that do not provide adequate support or cushioning can place additional stress on the Achilles tendon. High heels and poorly fitting shoes are common culprits.
- Sudden Increase in Activity Level A rapid increase in physical activity, intensity, or duration without proper conditioning can overload the Achilles tendon. This is often seen in people who start a new exercise regimen or significantly ramp up their training.
- Inadequate Stretching and Warm-Up Failing to properly stretch and warm up before engaging in physical activities can lead to tight calf muscles, increasing the strain on the Achilles tendon and contributing to the development of tendonitis.
Symptoms of Achilles Tendonitis
Achilles tendonitis presents with a range of symptoms that can vary in intensity. Recognising these symptoms early can help in seeking timely medical intervention. Common symptoms include:
- Pain
Pain is typically experienced along the back of the leg near the heel. The pain may start as a mild ache and gradually worsen with activity. It is often more severe after prolonged periods of inactivity, such as first thing in the morning. - Stiffness
Stiffness in the Achilles tendon, especially in the morning or after periods of rest, is a common symptom. The stiffness usually improves with mild activity or stretching. - Difficulty Walking
Severe pain and stiffness can make walking difficult. Activities that involve pushing off the foot, such as climbing stairs or running, may become particularly challenging. - Tenderness
Tenderness to the touch along the Achilles tendon, particularly when pressed, is a frequent symptom. This tenderness may extend from the heel to several inches above the heel. - Swelling
Inflammation can cause swelling along the Achilles tendon. The area may feel warm to the touch and appear visibly swollen.
Diagnosis of Achilles Tendonitis
Diagnosing Achilles tendonitis involves a combination of a thorough medical history, physical examination, and imaging studies. The following steps are typically taken to confirm the diagnosis:
Medical History
The doctor will begin by taking a detailed medical history, asking about the onset of symptoms, activity levels, recent changes in physical activity, and any previous injuries to the Achilles tendon or calf muscles.
Physical Examination
During the physical examination, the doctor will inspect the affected area for signs of swelling, tenderness, and thickening of the tendon. They will also assess the range of motion and strength of the ankle and calf muscles. Specific tests, such as the Thompson test, may be performed to evaluate the integrity of the Achilles tendon.
Imaging Studies
Imaging studies are often used to confirm the diagnosis and assess the extent of the injury. Common imaging techniques include:
- Ultrasound: Ultrasound imaging uses sound waves to create detailed images of the Achilles tendon. It is useful for detecting inflammation, tears, and degenerative changes in the tendon.
- Magnetic Resonance Imaging (MRI): MRI provides detailed images of the Achilles tendon and surrounding structures. It is particularly helpful in identifying the severity of the tendonitis, including the presence of partial or complete tears.
Treatment Options for Achilles Tendonitis
Treatment for Achilles tendonitis aims to reduce pain, inflammation, and promote healing of the affected tendon. The treatment approach can be conservative or, in severe cases, surgical. Here are the common treatment options:
Non-Surgical Treatment Options
Below are some of the most commonly recommended non-surgical treatment options for Achilles tendonitis:
- Rest and Activity Modification: Resting the affected leg and reducing activities that exacerbate the pain, such as running or jumping, are crucial initial steps. Gradually reintroducing activities and avoiding sudden increases in intensity can prevent further strain on the tendon.
- Ice Therapy: Applying ice packs to the affected area for 15-20 minutes several times a day can help reduce inflammation and alleviate pain. Ice should be wrapped in a cloth to avoid direct contact with the skin.
- Medications: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help manage pain and reduce inflammation. These medications should be used as directed by a doctor.
- Orthotics: Custom orthotic devices or shoe inserts can provide better support and alignment for the feet, reducing strain on the Achilles tendon. Heel lifts can also help decrease tension on the tendon.
- Physiotherapy: A tailored exercise programme can be developed to strengthen the calf muscles and improve flexibility, which can aid in the recovery process. Stretching and eccentric exercises are particularly beneficial.
- Supportive Footwear or Braces: Wearing supportive footwear or braces can help reduce stress on the Achilles tendon during activities. These aids can provide additional stability and support, facilitating the healing process.
Surgical Treatment Options
Surgery is considered when conservative treatments fail to provide relief or if there is a significant tear in the tendon. Surgical options include:
Debridement
This procedure involves removing damaged tissue from the Achilles tendon, which can help reduce pain and improve function. The goal is to excise the unhealthy portions of the tendon to promote healing and restore normal function.
Tendon Repair
For severe tears, the doctor may need to repair the tendon by stitching the torn ends together or using a graft to reinforce the tendon. Grafts can be taken from other parts of the body or be synthetic. This procedure aims to restore the tendon’s integrity and strength, allowing for better movement and less pain.
Prevention of Achilles Tendonitis
Preventing Achilles tendonitis involves adopting habits and practices that reduce the risk of overuse and strain on the Achilles tendon. Here are some strategies to help prevent this condition:
- Proper Footwear - Wearing shoes that provide adequate support, cushioning and fit well can reduce stress on the Achilles tendon. Avoid high heels and shoes that are worn out or lack proper arch support.
- Gradual Increase in Activity - It is important to start a new exercise regimen or gradually increase the intensity of physical activities. Sudden increases in activity levels can overload the Achilles tendon.
- Regular Stretching and Strengthening - To maintain flexibility, incorporate regular stretching exercises for the calf muscles and Achilles tendon. Strengthening exercises, particularly eccentric exercises, can help build resilience in the tendon.
- Warm-Up and Cool-Down - Always perform a thorough warm-up before engaging in physical activities and a cool-down afterwards. This helps prepare the muscles and tendons for activity and reduces the risk of injury.
- Cross-Training - Engage in a variety of physical activities to avoid repetitive strain on the Achilles tendon. Cross-training with low-impact exercises, such as swimming or cycling, can provide a balanced workout and reduce the risk of overuse injuries.
- Proper Technique - Ensure that sports and exercise techniques are performed correctly. Poor form can place additional strain on the Achilles tendon and increase the risk of injury.
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38 Irrawaddy Road #08-41
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Frequently Asked Questions (FAQs)
How can Achilles tendonitis be prevented?
Preventative measures include wearing proper footwear, gradually increasing activity levels, regular stretching and strengthening exercises, proper warm-up and cool-down routines, cross-training, maintaining proper technique, listening to your body, and maintaining a healthy weight.
When should I seek medical attention for Achilles tendonitis?
Seek medical attention if you experience persistent pain, significant swelling and stiffness, difficulty walking, an audible popping sound, limited range of motion, no improvement with conservative treatments, or recurring symptoms.
Can Achilles tendonitis lead to complications?
Yes, if left untreated, Achilles tendonitis can lead to more severe complications, such as tendon ruptures, which may require surgical intervention.
Is Achilles tendonitis the same as Achilles tendinosis?
No, Achilles tendonitis refers to inflammation of the tendon, often due to acute injury or overuse. Achilles tendinosis involves degeneration of the tendon tissue, typically resulting from chronic overuse.