Achilles tendinitis describes an inflammatory change of the Achilles tendon without a tear of the tendon. Achilles tendinitis may be acute or chronic. The
onset of pain is usually unilateral but may be found bilaterally. Achilles tendinitis is common in the third or fourth decade of life in patients who are active with sports or in jobs that require
physical labor. Pain is described at the insertion of the tendon in the heel bone or in the body of the tendon.
Some of the causes of Achilles tendonitis / tendinosis include. Overuse injury - this occurs when the Achilles tendon is stressed until it develops small tears. Runners seem to be the most
susceptible. People who play sports that involve jumping, such as basketball, are also at increased risk. Arthritis - Achilles tendonitis can be a part of generalised inflammatory arthritis, such as
ankylosing spondylitis or psoriatic arthritis. In these conditions both tendons can be affected. Foot problems - some people with over pronated feet (Flat Feet) or feet that turn inward while walking
are prone to Achilles tendonitis. The flattened arch pulls on calf muscles and keeps the Achilles tendon under tight strain. This constant mechanical stress on the heel and tendon can cause
inflammation, pain and swelling of the tendon. Being overweight can make the problem worse. Footwear - wearing shoes with minimal support while walking or running can increase the risk, as can
wearing high heels. Overweight and obesity - being overweight places more strain on many parts of the body, including the Achilles tendon.
Morning pain is a hallmark symptom because the achilles tendon must tolerate full range of movement including stretch immediately on rising in the morning. Symptoms are typically localized to the
tendon and immediate surrounding area. Swelling and pain at the attachment are less common. The tendon can appear to have subtle changes in outline, becoming thicker in the A-P and M-L planes. With
people who have a tendinopathy of the achilles tendon that has a sensitive zone, combined with intratendinous swelling, that moves along with the tendon and of which sensitivity increases or
decreases when the tendon is put under pressure, there will be a high predictive value that in this situation there is a case of tendinosis.
A doctor examines the patient, checking for pain and swelling along the posterior of the leg. The doctor interviews the patient regarding the onset, history, and description of pain and weakness. The
muscles, tissues, bones, and blood vessels may be evaluated with imaging studies, such as X-ray, ultrasound, or MRI.
Your podiatrist may recommend one or more of these treatments to manage your pain. A bandage specifically designed to restrict motion of the tendon. Over the counter, non-steroidal anti-inflammatory
medication (ibuprofen). Custom orthotic shoe inserts to relieve stress on the tendon. Rest. Switching to a low impact exercise such as swimming, that does not stress the tendon. Stretching, massage,
ultrasound and appropriate exercises to strengthen the muscles that support the achilles tendon. In extreme cases, surgery is necessary to remove the damaged tissue and repair any tears.
Percutaneous Achilles Tendon Surgery. During this procedure the surgeon will make 3 to 4 incisions (approx. 2.5 cm long) on both sides of the Achilles tendon. Small forceps are used to free the
tendon sheath (the soft tissue casing around your Achilles tendon) to make room for the surgeon to stitch/suture any tears. Skilled surgeons may perform a percutaneous achilles tendon surgery with
ultrasound imaging techniques to allow for blink suturing with stab incisions made by a surgical suture needle. This procedure can be done in 3 different ways depending on the preference and
experience of your surgeon. Instead of making several 2.5 cm incisions for this procedure, some surgeons will use guided imaging with an ultrasound to see the Achilles tendon tissue without having to
open up your ankle. For this technique, they will use a surgical needle to repeatedly stab your Achilles tendon. These "stab incisions" will allow the surgeon to "blindly" suture your tendon without
seeing the actual tissue. As another option - some surgeons will only make 1 to 3 incisions for smaller surgical implements to repair your tendon while relying on imaging ultrasound to see your
damaged tissue. During either procedure the use of ultrasound imaging or endoscopic techniques requires a very skilled surgeon.
A 2014 study looked at the effect of using foot orthotics on the Achilles tendon. The researchers found that running with foot orthotics resulted in a significant decrease in Achilles tendon load
compared to running without orthotics. This study indicates that foot orthoses may act to reduce the incidence of chronic Achilles tendon pathologies in runners by reducing stress on the Achilles
tendon1. Orthotics seem to reduce load on the Achilles tendon by reducing excessive pronation,