The Achilles tendon is the thickest and strongest tendon in your body, connecting your calf muscles to the back of your heel. Virtually all of the force generated when you ?toe
off? the ground during running is transmitted by the Achilles, and this force can be as much as three times your body weight. And the faster you run, the more strain you put on the Achilles tendon.
As such, it?s prone to injury in many runners, but particularly those who do a lot of fast training, uphill running, or use a forefoot-striking style. Achilles tendon injuries account for 5-12% of
all running injuries, and occur disproportionately in men. This may be because of the faster absolute speeds men tend to train at, or may be due to other biomechanical factors.
There are a number of ways a person can develop Achilles tendinitis. Some causes are easier to avoid than others, but being aware of them can aid earlier diagnosis and help prevent serious injury.
Causes of Achilles tendinitis include, using incorrect or worn out shoes when running or exercising. Not warming up properly before exercise. Increasing intensity of exercise too quickly (e.g.
running speed or distance covered). Prematurely introducing hill running or stair climbing to exercise routine. Running on hard or uneven surfaces. Calf muscle is injured or has little flexibility
(this puts a lot of strain on the Achilles tendon). Sudden intense physical activity such as sprinting for the finish line. Achilles tendinitis can also be caused by differences in foot, leg or ankle
anatomy. For example, some people can have flatness in their foot where there would normally be an arch; this puts more strain on the tendon. The FDA has asked that a boxed warning be added to the
prescribing information for fluoroquinolone antibiotics. Patients taking these drugs may experience an increased risk of tendinitis and tendon rupture. Fluoroquinolones include Cipro (ciprofloxacin),
Factive (gemifloxacin), Levaquin (levofloxacin), Avelox (moxifloxacin), Noroxin (norfloxacin), Floxin (ofloxacin) and Proquin (ciprofloxacin hydrochloride). It is important to remember that the risk
for injury is not necessarily gone when the drug is stopped. Cases have been reported in which tendon problems occurred up to several months after the drug was discontinued.
Patients with an Achilles tendon rupture frequently present with complaints of a sudden snap in the lower calf associated with acute, severe pain. The patient reports feeling like he or she has been
shot, kicked, or cut in the back of the leg, which may result in an inability to ambulate further. A patient with Achilles tendon rupture will be unable to stand on his or her toes on the affected
side. Tendinosis is often pain free. Typically, the only sign of the condition may be a palpable intratendinous nodule that accompanies the tendon as the ankle is placed through its range of motion
(ROM). Patients with paratenonitis typically present with warmth, swelling, and diffuse tenderness localized 2-6 cm proximal to the tendon's insertion. Paratenonitis with tendinosis. This is
diagnosed in patients with activity-related pain, as well as swelling of the tendon sheath and tendon nodularity.
The diagnosis is made via discussion with your doctor and physical examination. Typically, imaging studies are not needed to make the diagnosis. However, in some cases, an ultrasound is useful in
looking for evidence of degenerative changes in the tendon and to rule out tendon rupture. An MRI can be used for similar purposes, as well. Your physician will determine whether or not further
studies are necessary.
Conservative management of Achilles tendinosis and paratenonitis includes the following. Physical therapy. Eccentric exercises are the cornerstone of strengthening treatment, with most patients
achieving 60-90% pain relief. Orthotic therapy in Achilles tendinosis consists of the use of heel lifts. Nonsteroidal anti-inflammatory drugs (NSAIDs): Tendinosis tends to be less responsive than
paratenonitis to NSAIDs. Steroid injections. Although these provide short-term relief of painful symptoms, there is concern that they can weaken the tendon, leading to rupture. Vessel sclerosis.
Platelet-rich plasma injections. Nitric oxide. Shock-wave therapy. Surgery may also be used in the treatment of Achilles tendinosis and paratenonitis. In paratenonitis, fibrotic adhesions and nodules
are excised, freeing up the tendon. Longitudinal tenotomies may be performed to decompress the tendon. Satisfactory results have been obtained in 75-100% of cases. In tendinosis, in addition to the
above procedures, the degenerated portions of the tendon and any osteophytes are excised. Haglund?s deformity, if present, is removed. If the remaining tendon is too thin and weak, the plantaris or
flexor hallucis longus tendon can be weaved through the Achilles tendon to provide more strength. The outcome is generally less favorable than it is in paratenonitis surgery.
In cases of severe, long-term Achilles tendonitis the sheath may become thick and fibrous. In these cases surgery may be recommended. Surgery aims to remove the fibrous tissue and repair any tears in
the tendon. A cast or splint will be required after the operation and a recovery program including physiotherapy, specific exercises and a gradual return to activity will be planned.
You can take measures to reduce your risk of developing Achilles Tendinitis. This includes, Increasing your activity level gradually, choosing your shoes carefully, daily stretching and doing
exercises to strengthen your calf muscles. As well, applying a small amount ZAX?s Original Heelspur Cream onto your Achilles tendon before and after exercise.