Achilles tendon is the largest tendon in the body. It connects the calf muscles to the heel and is active during almost all activities including walking, jumping, and swimming. This dense tendon can
withstand large forces, but can become inflamed and painful during periods of overuse. Pain results from inflammation (tendonitis) or a degenerating tendon (tendinosis). Achilles tendon pathologies
include rupture and tendonitis. Many experts now believe, however, that tendonitis is a misleading term that should no longer be used, because signs of true inflammation are almost never present on
histologic examination. Instead, the following histopathologically determined nomenclature has evolved. Paratenonitis: Characterized by paratenon inflammation and thickening, as well as fibrin
adhesions. Tendinosis: Characterized by intrasubstance disarray and degeneration of the tendon.
Achilles tendonitis is aggravated by activities that repeatedly stress the tendon, causing inflammation. In some cases even prolonged periods of standing can cause symptoms. In many people who have
developed achilles tendonitis, chronic shortening of the gastroc-soleus muscle complex is the reason that home remedies and anti-inflammatory medications fail. In these instances the muscle itself
becomes shortened and creates a constant stress at the tendon?s attachment. Like a green branch that is slowly bent, eventually it begins to breakdown. Over a prolonged period the tendon becomes
inflamed, and in the worst cases, appears swollen and thickened. In certain circumstances attempts to heal have failed and the body?s inability to heal the tissue results in degenerative changes
known as achilles tendonosis. Anti-inflammatory medication, stretching and ice may only provide temporary relief, because they address the inflammation but not the root cause.
The main complaint associated with Achilles tendonitis is pain behind the heel. The pain is often most prominent in an area about 2-4 centimeters above where the tendon attaches to the heel. In this
location, called the watershed zone of the tendon, the blood supply to the tendon makes this area particularly susceptible. Patients with Achilles tendonitis usually experience the most significant
pain after periods of inactivity. Therefore patients tend to experience pain after first walking in the morning and when getting up after sitting for long periods of time. Patients will also
experience pain while participating in activities, such as when running or jumping. Achilles tendonitis pain associated with exercise is most significant when pushing off or jumping.
During the physical exam, your doctor will gently press on the affected area to determine the location of pain, tenderness or swelling. He or she will also evaluate the flexibility, alignment, range
of motion and reflexes of your foot and ankle. Your doctor may order one or more of the following tests to assess your condition, X-rays. While X-rays can't visualize soft tissues such as tendons,
they may help rule out other conditions that can cause similar symptoms. Ultrasound. This device uses sound waves to visualize soft tissues like tendons. Ultrasound can also produce real-time images
of the Achilles tendon in motion. Magnetic resonance imaging (MRI). Using radio waves and a very strong magnet, MRI machines can produce very detailed images of the Achilles tendon.
Treatment normally includes, A bandage, designed specifically to restrict motion of the tendon. Non-steroidal anti-inflammatory medication. Orthoses (devices to help to support the muscle and relieve
stress on the tendon, such as a heel pad or shoe insert. Rest, and switching to an exercise, such as swimming, that does not stress the tendon. Stretching, massage, ultrasound and appropriate
exercises to strengthen the weak muscle group in front of the leg and the upper foot flexors. In extreme cases, surgery is performed, to remove fibrous tissue and repair any tears.
Surgical treatment for tendons that fail to respond to conservative treatment can involve several procedures, all of which are designed to irritate the tendon and initiate a chemically mediated
healing response. These procedures range from more simple procedures such as percutaneous tenotomy61 to open procedures and removal of tendon pathology. Percutaneous tenotomy resulted in 75% of
patients reporting good or excellent results after 18 months. Open surgery for Achilles tendinopathy has shown that the outcomes are better for those tendons without a focal lesion compared with
those with a focal area of tendinopathy.62 At 7 months after surgery, 67% had returned to physical activity, 88% from the no-lesion group and 50% from the group with a focal lesion.
If you're just getting started with your training, be sure to stretch after running, and start slowly, increasing your mileage by no more than 10% per week. Strengthen your calf muscles with
exercises such as toe raises. Work low-impact cross-training activities, such as cycling and swimming, into your training.