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Achilles tendinopathy

Achilles tendinopathy is a disorder in which pain, stiffness, and swelling occur in the Achilles tendon. This tendon is a band of fibrous tissue found right above the heels and joins the calf muscles with the heel bone (calcaneum).

The role of the Achilles tendon is to allow plantarflexion (bending of the feet downwards at the ankles). Achilles tendinopathy is considered to occur due to repetitive small injuries, called microtrauma, in the Achilles tendon.

Achilles tendinopathy is common in runners or middle-aged people who play sports once a week. Treatment of Achilles tendinopathy is simple. Mild to moderate Achilles’ tendinopathy can be treated at home under the supervision of a physiotherapist. Practising self-care strategies is essential to avoid repeated microtrauma. For severe cases, prolotherapy may be required.

A physiotherapist treating Achilles tendinopathy

What Are the Symptoms of Achilles Tendinopathy?

The symptoms of Achilles tendinopathy include the following.

  • Difficulty when walking – walking becomes impossible with pain.
  • Pain at the back of your heel.
  • Tenderness, swelling, and warmth at the site of the Achilles tendon.
  • Symptoms according to severity Achilles’ tendinopathy
    • Mild – in mild cases, pain occurs in the Achilles tendon either during or after activity, for example, running.
    • Moderate – in some moderate cases, the Achilles tendon can swell, a nodule or hard lump may be formed in the tendon
    • Severe – pain occurs in any activity in which weight-bearing is present. Sometimes, the Achilles tendon can tear or rupture, feeling like a hard whack on the heel.

Causes of Achilles Tendinopathy

There are several causes of Achilles tendinopathy. These include:

  • Overuse injury – stress on the Achilles tendon leads to slight degeneration and tears. Runners are more prone to getting the condition. Individuals who play sports that include jumping, for example, basketball, are also at a higher risk.
  • Arthritis – Generalized inflammatory arthritis, including psoriatic arthritis or ankylosing spondylitis, can cause Achilles’ tendonitis. In such cases, both tendons may be affected.
  • Foot problems – People who have flat or hyper-pronated feet; those that have an inward turn during walking are susceptible to Achilles’ tendonitis. The calf muscles remain pulled because of the flattened arch, keeping the Achilles tendon under tight strain. Continuous mechanical stress on the tendon and heel can lead to pain, inflammation, and swelling of the tendon.
  • Footwear – shoes that have minimal support for walking and running as well as wearing heels can elevate the risk.
  • Overweight and obesity – excessive weight can put a lot of weight on the Achilles tendon.
  • Quinolone antibiotics – side effects of quinolones include Achilles’ tendon rupture that can lead to Achilles’ tendinopathy.

How Is Achilles Tendinopathy Diagnosed?

Consult your healthcare professional in case you have any symptoms of Achilles tendinopathy.

Your clinician will use the following methods to diagnose your condition.

  • Medical history – your profession, habits, exercise routine, footwear, etc.
  • Physical examination –examination of tenderness and thickness of the Achilles tendon
  • Tests – including foot x-ray, ultrasound, and at times blood tests to check inflammation, and MRI scan.

Treatment of Achilles Tendinopathy

Several treatments are available to ease Achilles’ tendinopathy. Your doctor will start with conservative treatment first while indicating surgery only for severe cases.

Rest

Taking rest and gap from sports are essential for Achilles’ tendinopathy. High-impact activities like running should be stopped. With the improvement of pain, you can gradually start exercising. However, complete long-term rest can actually exacerbate the condition rather than heal it.

Painkillers

Painkillers like ibuprofen or paracetamol can ease out your pain. Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that shouldn’t be used for more than 7 to 14 days in Achilles tendinopathy. They may mask Achilles tendinopathy symptoms and hinder healing.

Other side effects of NSAIDs include stomach pain and bleeding. Consult your doctor before taking these medicines.

Ice packs

Ice therapy can help to control pain while also decreasing swelling in the initial phases of Achilles tendinopathy. Apply the ice pack for at least 10-30 minutes. Avoid exceeding more than 30 minutes as it can cause skin damage. Press the ice pack on the injury gently to decrease blood flow to the affected area and improve pain.

Achilles Tendon Exercises

Certain exercises help to strengthen your Achilles tendons. These should be practised every day for controlling pain and stiffness. You can consult a physiotherapist for guidance. Other treatments like ultrasound and massage can also be used to relieve your symptoms.

Orthotics

Orthotics recommends changing footwear or adding special inserts in shoes to help decrease pain and other symptoms.

Steroid injections

If your condition doesn’t improve, your doctor may recommend steroid injection for tendon injuries. However, using steroids can have other side effects, including tearing of the tendon.

Non-invasive treatments

Achilles tendinopathy symptoms generally go away within 3 to 6 months with conservative treatment. However, in case your symptoms do not improve after 3 to 6 months of treatment, your clinician may refer you to a sports medicine doctor or an orthopaedic surgeon who can recommend one of the following treatments.

  1. Extracorporeal shock-wave therapy – Sound waves are used and passed through the skin over your Achilles tendon. This is considered a safe procedure with little risk of adverse effects. Some side effects that may occur are rare and can include reddening skin and pain in the calf. There is a small risk of rupture but in older people.
  2. Injection using your own blood – your specialist will draw it and inject it into your Achilles tendon – known as autologous blood injection. This treatment will promote healing by enhancing cell growth. An ultrasound scan can guide the injection. However, the effectiveness of this therapy is not confirmed as its long-term effects are unclear.

Surgery

The cases of Achilles tendinopathy are rare, affecting only about 1 in 4 individuals having persisting pain. These people will recommend surgery for their treatment. In most cases, surgery produces good results, relieving pain. The surgical procedure comprises the following.

  • Removal of adhesions or nodules developed inside the damaged tendon.
  • Placement of a lengthwise cut inside the tendon that stimulates tendon healing.

Complications after surgery are rare and include issues with wound healing.

The Bottom Line

Achilles’ tendinopathy is not a life-threatening condition but can involve continuous discomfort, impacting the quality of life. However, if it is promptly diagnosed and treated, it has a better prognosis and quick healing.

References:

  1. Mayoclinic staff. Achilles tendinopathy. Mayoclinic. Sept, 2019.https://www.mayoclinic.org/diseases-conditions/achilles-tendinitis/symptoms-causes/syc-20369020
  2. Knott L. Achilles tendinopathy. Patient. Nov, 2020.https://patient.info/foot-care/heel-and-foot-pain-plantar-fasciitis/achilles-tendinopathy
  3. Hoffman M. Picture of the Achilles Tendon. webMD. Jun, 2021.https://www.webmd.com/fitness-exercise/picture-of-the-achilles-ten

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