The Achilles tendon connects the foot from the calcaneus, which is the heel bone, to the leg’s calf muscles. This tendon is the largest tendon in the body and is one of the most important tendons in the lower extremity since its function is to allow the foot to plantarflex, which means to point the foot down.
Without proper functioning of the Achilles tendon, you would be unable to stand on your toes, walk, run, and jump. The Achilles tendon takes on the weight of the entire body at low activity levels, but with high levels of exercise there may be 3-12 times the amount of weight put on the tendon. This can be a huge problem for patients as it my lead to tendinosis.
Tendinosis is thickening and irritation to the tendon and is caused by straining and long term microtrauma to the Achilles tendon. You may also hear doctors refer to Achilles tendinosis as Achilles tendonitis. Signs and symptoms of Achilles tendinosis include:
• Tendon is especially stiff in the morning
• Constant swelling
• Inability to stand on toes
• A bone spur at the back of the heel
There are two types of Achilles tendinosis that define where the tendon has been injured. The two types are insertional and non-insertional Achilles tendinosis.
• Insertional Achilles tendinosis symptoms will be located at insertion of the tendon, which specifically is at the back of the heel at the middle one third. Anyone can get insertional Achilles tendinosis even those who do not have a high activity level.
• Non-insertional Achilles tendinosis is usually most common in athletes and the tendon will be injured within the tendon above the heel.
The causes of Achilles tendinosis include:
• Sudden movement or jumping, which can cause injury to a tendon
• Exercising too much too fast, which is often common in those patients who decide to try to get back in shape, so it is important to start exercise programs slowly.
• Tight calf muscles and Achilles tendon, which is referred to as equinus. Most patients have some degree of equinus. It is always important to adequately stretch before and after exercise.
• Bone spur on the back heel may rub against the tendon and cause irritation and damage.
There are many different treatments for Achilles tendinosis both non-surgical and surgical. Non-surgical treatment includes:
• Taking a break from exercising to allow the tendon to rest; you may also be put in a boot or a cast that prevents movement of the tendon for 4-6 weeks
• Elevating your leg above the level of your heart while icing the tendon to help get rid of the swelling in the area
• Non-steroidal anti-inflammatory medications. Some patients may find that these medications may cause stomach upset, but they are usually effective at getting rid of inflammation and swelling. There are over the counter anti-inflammatories such as Ibuprofen or prescription strength such as Naproxen.
• Purchasing a new pair of shoes that has adequate cushioning and/or a custom pair of orthoses to wear in your shoes.
• Calf stretch also known as runner’s stretch, which will help to stretch out tight calf muscles and a tight tendon, which will take additional strain off of the tendon. This stretch is done by putting one knee bent forward with the opposite leg back while pushing against a wall. It is important to leave both heels on the ground in order to get adequate stretching. The stretch should be held for 20 seconds. Never stretch to the point where it causes pain.
• Heel lift stretch will also stretch the tight calf muscles and tendon. Stand on the edge of the stairs or a block and while holding onto a railing, slowly drop your heels downward and then bring your heels back up. Do this 15-20 times. Once again if you experience pain stop stretching.
There are numerous surgical procedures to correct a severe tendinosis or repair a tendon that has ruptured. Without treatment, Achilles tendinosis may lead to Achilles rupture. So before it gets that severe, schedule an appointment at Boulder County Foot and Ankle for further evaluation and treatment.
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American Academy of Podiatric Sports Medicine