ACHILLES TENDONITIS
 

Description

Achilles tendonitis is characterized pain in the Achilles tendon (back of the ankle). Achilles tendonitis usually results from sudden increase in amount or intensity of activity or a direct blow  to the lower leg, foot, or ankle that results in a sudden lengthening of the tendon against resistance.

There are 3 types of tendon strains. A grade 1 strain is a mild strain. There is a slight pull of the tendon microscopic tendon tearing with no loss of strength or change in tendon length. A grade 2 strain is characterized by tearing of tendon fibers within the tendon or at the tendon bone junction. The length of the tendon is increased, and strength is usually decreased. A grade 3 strain is a complete rupture of the tendon. Achilles tendonitis is usually a grade 1 or 2 strain of the tendon. However, when the Achilles tendon in patients with chronic tendonitis is examined under microscope, there is a characteristic lack of inflammatory  findings suggesting that there is more to this injury than a simple overuse syndrome.

Risk increases with sports that require sudden, explosive calf muscle contraction with jumping and quick starts like basketball and racquet sports.

An acute injury is usually curable within 6 weeks if treated appropriately rest and proper rehabilitation.
A chronic condition may take up to 8 to 10 months to heal. Recovery is usually quicker if the injury is due to a direct blow. Healing time will be prolonged if the condition is not appropriately treated or if not given adequate time to heal. Symptoms can reoccur if activity is resumed too soon. Untreated, or improperly treated Achilles tendonitis may result in tendon rupture requiring surgery or prolonged casting of the foot and ankle.

Symptoms

Pain, tenderness, swelling, warmth, and redness of the Achilles tendon
Pain with pushing off or pushing down with the front of the foot or standing on the ball of the foot

Crepitation (a crackling sound) when moving the foot up and down.


Treatment
Initial treatment consists of medication and ice to relieve the pain, stretching and strengthening exercises, and modification of the activity that initially caused the problem. Occasionally, a heel lift may be prescribed to reduce stress to the tendon. This may be followed by an elastic bandage wrap of the ankle and Achilles tendon. Orthotics may be required to correct biomechanical factors that can exacerbate or predispose an athlete to this type of injury. Surgery to remove the damaged tendon lining or degenerated tendon tissue is rarely necessary and has not been shown to have better results than conservative management.

Cortisone injections are rarely  indicated. Cortisone injections in weight bearing tendons like the patella and Achilles tendons can cause tendon rupture.

Heat and Cold
Cold is used to relieve pain and reduce inflammation for acute and chronic Achilles tendinitis. Cold should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.
 

Cold should be applied for 20 minutes 4 times daily. Occasionally a referral to a physical therapist or athletic trainer is indicated for rehabilitation management. Crutches may be recommended for the first 24 to 72 hours if the injury is severe.

The initial phase of rest, ice, and elevation usually lasts 72 hours and is followed by a graduated program of stretching and strengthening. It is especially important to concentrate on increasing the endurance of the injured area muscles and supporting muscles to help prevent future injury. One often neglected part of rehabilitation involves re-training proprioception in the injured area. This has also been shown to help reduce the incidence of re-injury.