Achilles tendinitis can be a very crippling issue for runners - simply because the pain is enough to discourage loading of the foot. It can also be a tricky condition to treat
because the tendon is not as heavily vascularized (i.e. more blood flow) as muscle, and therefore lacks healing potential. It is highly recommended that you see a physical therapist as soon as you
experience acute symptoms, so chronic tendonosis (which is longer termed and harder to treat) does not set in.
Hill running or stair climbing. Overuse resulting from the natural lack of flexibility in the calf muscles. Rapidly increasing mileage or speed. Starting up too quickly after a layoff. Trauma caused
by sudden and hard contraction of the calf muscles when putting out extra effort such as in a final sprint. Achilles tendinitis often begins with mild pain after exercise or running that gradually
Most cases of Achilles tendonitis start out slowly, with very little pain, and then grow worse over time. Some of the more common symptoms include mild pain or an ache above the heel and in the lower
leg, especially after running or doing other physical activities, pain that gets worse when walking uphill, climbing stairs, or taking part in intense or prolonged exercise, stiffness and tenderness
in the heel, especially in the morning, that gradually goes away, swelling or hard knots of tissue in the Achilles tendon, a creaking or crackling sound when moving the ankle or pressing on the
Achilles tendon, weakness in the affected leg.
X-rays are usually normal in patients with Achilles tendonitis, but are performed to evaluate for other possible conditions. Occasionally, an MRI is needed to evaluate a patient for tears within the
tendon. If there is a thought of surgical treatment an MRI may be helpful for preoperative evaluation and planning.
Supportive shoes and orthotics. Pain from insertional Achilles tendinitis is often helped by certain shoes, as well as orthotic devices. For example, shoes that are softer at the back of the heel can
reduce irritation of the tendon. In addition, heel lifts can take some strain off the tendon. Heel lifts are also very helpful for patients with insertional tendinitis because they can move the heel
away from the back of the shoe, where rubbing can occur. They also take some strain off the tendon. Like a heel lift, a silicone Achilles sleeve can reduce irritation from the back of a shoe. If your
pain is severe, your doctor may recommend a walking boot for a short time. This gives the tendon a chance to rest before any therapy is begun. Extended use of a boot is discouraged, though, because
it can weaken your calf muscle. Extracorporeal shockwave therapy (ESWT). During this procedure, high-energy shockwave impulses stimulate the healing process in damaged tendon tissue. ESWT has not
shown consistent results and, therefore, is not commonly performed. ESWT is noninvasive-it does not require a surgical incision. Because of the minimal risk involved, ESWT is sometimes tried before
surgery is considered.
Surgery is considered the last resort. It is only recommended if all other treatment options have failed after at least six months. In this situation, badly damaged portions of the tendon may be
removed. If the tendon has ruptured, surgery is necessary to re-attach the tendon. Rehabilitation, including stretching and strength exercises, is started soon after the surgery. In most cases,
normal activities can be resumed after about 10 weeks. Return to competitive sport for some people may be delayed for about three to six months.
The following measures can significantly reduce the risk of developing Achilles tendonitis. Adequately stretch and warm up prior to exercise. Warm down and stretch after exercise. Choose footwear
carefully and use footwear appropriate to the sport being undertaken. Use orthotic devices in footwear to correctly support the foot. Exercise within fitness levels and follow a sensible exercise
programme. Develop strong, flexible calf muscles.