Are You at Risk for Developing Achilles Tendonitis?

Risk Factors and Causes:
Achilles tendonitis often develops following sudden changes in activity level, training on poor surfaces, or wearing inappropriate footwear. The condition also may develop in people who exercise infrequently and in those who are just beginning an exercise program, because inactive muscles and tendons have little flexibility. It is important for people who are just starting to exercise to stretch properly, start slowly, and increase gradually. Poorly conditioned athletes are at the highest risk for developing this condition. Participating in activities that involve sudden stops and starts and repetitive jumping, such as basketball, increases the risk for the condition. Patients who develop arthritis in the heel have an increased risk for developing Achilles tendonitis.

Achilles tendonitis may be caused by a single incident of overstressing the tendon, or it may result from a series of stresses that produce small tears over time.

Women who wear high-heeled shoes often and switch to sneakers for exercise also can develop Achilles tendonitis. The Achilles tendon and lower leg muscles gradually adapt to a shortened position because the shoes prevent the heel from stretching all the way to the ground. When this occurs, wearing sneakers or flat shoes forces the Achilles tendon to stretch further than it is accustomed to, causing inflammation. If high heels are worn everyday, stretching should be done every morning and night to keep the Achilles tendon lengthened.

Signs and Symptoms:
In most cases, symptoms of Achilles tendonitis 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. This condition causes the calf muscles to stretch more than normal. The further they stretch, the tighter they become. The force on the Achilles tendon and the heel bone increases, resulting in Achilles tendonitis.

Patients with tendinosis, a chronic inflammation of the tendon, may experience a sensation of fullness in the back of the lower leg or develop a hard knot of tissue called a nodule.

Treatment:
Treatment depends on the severity of the injury. If heel pain, tenderness, swelling, or discomfort in the back of the lower leg occurs, physical activity that produces the symptoms should be discontinued.


If the problem returns or persists, a podiatrist should be consulted. If pain develops even with proper stretching and training techniques, the podiatrist will check for hyperpronation and adequate arch support. The addition of an orthotic may be enough to maintain good arch and foot alignment and eliminate pain.

If damage to the tendon is minor, the injury may respond to a simple course of treatment known as RICE (rest, ice, compression, elevation). A nonsteroidal anti-inflammatory drug such as ibuprofen may be used to reduce pain, swelling, and inflammation.

Additional treatment may be required if injury to the tendon is severe, if mild Achilles tendonitis does not respond to basic treatment, or if symptoms return with the resumption of physical activity.

A flexible cast may be used to immobilize the foot and reduce swelling, and crutches may be used to keep weight off the foot. This treatment may be necessary for up to 8 weeks. If the injury responds to this treatment, the patient may then be advised to wear low-heeled shoes and perform rehabilitation exercises to gradually stretch the tendon before full activity is resumed.

Severe Achilles tendonitis, tendon rupture, or tearing away from the heel bone may require surgery and lengthy rehabilitation. Surgery involves removing the tendon's inflamed outer covering and reattaching the torn tissues. Following surgery, patients undergo physical therapy and strengthening exercises for 2–3 weeks. Most activities can be resumed in 6–10 weeks, and competitive sports usually can be resumed after 3–6 months.


Dr. Michele Summers Colon, DPM, MS
3503 Lexington Ave.
El Monte, CA 91731
(626) 442-1223

http://www.footdoc.moogo.com/


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