is one of the most common running injuries. The achilles tendon is the large tendon at the back of the ankle. It connects the calf muscles made up of the gastrocnemius and soleus to the heel bone or
calcaneus. It provides the power in the push off phase of walking and running where huge forces are transmitted through the achilles tendon. Achilles tendonitis is often now referred to as achilles
tendinopathy. This is because the term tendinopathy covers all types of overuse achilles tendon injury. Strictly speaking tendonitis suggests an inflammatory condition of the tendon but in reality
few achilles tendon injuries are actually down to pure inflammation. Soleus muscleThe main finding, particularly in older athletes is usually degeneration of the tissue with a loss of normal fibre
structure. Other very similar conditions may actually be due to inflammation or degeneration of the tendon sheath which surrounds the tendon rather than the achilles tendon itself. In addition to
being either chronic or acute, achilles tendonitis can also be at the attachment point to the heel called insertional achilles tendonitis or in the mid-portion of the tendon typically around 4cm
above the heel. Healing of the achilles tendon is often slow, due to its poor blood supply.
Achilles tendonitis most commonly occurs due to repetitive or prolonged activities placing strain on the Achilles tendon. This typically occurs due to excessive walking, running or jumping
activities. Occasionally, it may occur suddenly due to a high force going through the Achilles tendon beyond what it can withstand. This may be due to a sudden acceleration or forceful jump. The
condition may also occur following a calf or Achilles tear, following a poorly rehabilitated sprained ankle or in patients with poor foot biomechanics or inappropriate footwear. In athletes, this
condition is commonly seen in running sports such as marathon, triathlon, football and athletics.
In most cases, symptoms of Achilles tendonitis, also sometimes called Achilles tendinitis, develop gradually. Pain may be mild at first and worsen with continued activity. Repeated or continued
stress on the Achilles tendon increases inflammation and may cause it to rupture. Partial or complete rupture results in traumatic damage and severe pain, making walking virtually impossible and
requiring a long recovery period. Patients with tendinosis may experience a sensation of fullness in the back of the lower leg or develop a hard knot of tissue (nodule).
In diagnosing Achilles tendonitis or tendonosis, the surgeon will examine the patient?s foot and ankle and evaluate the range of motion and condition of the tendon. The extent of the condition can be
further assessed with x-rays or other imaging modalities.
In order to treat achilles tendinitis effectively, it is important to complete a thorough examination of the entire lower extremity. Once the true cause is identified, a comprehensive treatment
program can be initiated to reduce inflammation and improve any faulty lower extremity biomechanics. Treatment options may include biomechanical analysis of gait. Splinting/bracing to alleviate the
strain on the tendon. Soft tissue mobilization/manual therapy to decrease inflammation and promote healing of the tendon. Strengthening/flexibility and proprioceptive exercises. Home exercise
program. Modalities for pain and inflammation (i.e. ultrasound, iontophoresis, electrical stimulation, ice). Methods to alter faulty mechanics (i.e taping, orthotics). Education about lifestyle
changes (i.e. proper shoes, activity modification).
Occasionally, conservative management of Achilles tendon conditions fails. This failure is more common in older male patients and those with longstanding symptoms, those who persist in full training
despite symptoms or those who have uncorrected predisposing factors. In these cases, surgery may be indicated. It should be remembered, however, that the rehabilitation program, particularly for
severe Achilles tendon injuries, is a slow, lengthy program. Surgery is only indicated when there is failure to progress in the rehabilitation program. Surgery should not be considered unless at
least six months of appropriate conservative management has failed to lead to improvement.
Your podiatrist will work with you to decrease your chances of re-developing tendinitis. He or she may create custom orthotics to help control the motion of your feet. He or she may also recommend
certain stretches or exercises to increase the tendon's elasticity and strengthen the muscles attached to the tendon. Gradually increasing your activity level with an appropriate training
schedule-building up to a 5K run, for instance, instead of simply tackling the whole course the first day-can also help prevent tendinitis.