Achilles tendonitis | Sports Injuries

Achilles tendonitis The largest and strongest tendon
in the body, the Achilles tendon gets much use
and abuse, but it is not, like its Greek mythological
namesake, indestructible. It is susceptible to a
number of injuries, ranging from inflammation to
ACHILLES TENDON RUPTURE, many of which are generally
referred to as Achilles tendonitis. In general,
Achilles tendonitis refers to inflammation of the
tendon behind the ankle that connects the leg and
ankle to the heel bone. Specifically, the range of
Achilles tendon inflammation and degeneration is
classified as follows:
• Peritenonitis. Characterized by a burning pain
during or following activity, this occurs when the paratenon is inflamed and thickened. As the
disease gets worse, the pain may occur during
periods of little activity and even at rest. Prolonged
peritenosis may result in a ruptured
Achilles tendon.
• Tendinosis. People with tendinosis often describe
feeling a “nodule” or sensation of fullness at the
back of the leg. There is no swelling and no pain,
but the condition is degenerative of the tendon
fibers.

• Peritenonitis with tendinosis. A combination of the
two diseases above, this condition usually causes
activity-related pain and diffuse swelling, as well
as the “nodule” sensation.
Achilles tendonitis usually sets in following sudden
changes in activity or training level, use of
inappropriate footwear, or training on inappropriate
running surfaces. It is commonly seen in runners;
some estimates in the United States report an
incidence of Achilles tendonitis in 6.5–18 percent
of all runners.

Causes
Achilles tendonitis is most often caused by excessive
running or jumping without proper stretching
and strengthening. Uphill running in particular can
cause inflammation of the Achilles tendon. Injuries
to the tendon often occur in older, recreational
athletes, though they may occur in younger, wellconditioned
athletes, too. The following are common
causes of injury:
• overuse
• increased intensity of activity
• increased duration of training
• stairs
• hill climbing
• poor conditioning
• improper shoes
• improper training surfaces
• improper or lack of stretching exercises
Intrinsic causes may include the following:
• age
• tight Achilles tendon
• varus heel
• varus forefoot
• cavus foot
• tibia vara
• medical diseases that may affect tendon tissue,
which include diabetes mellitus, and diseases that require corticosteroid treatment, which
include lupus, asthma, and transplants

Diagnosis
Doctors diagnose Achilles tendonitis based on the
patient’s experience of pain behind the ankle when
running or jumping. Tenderness in the area over
the Achilles tendon and weakness in the calf muscles
further indicate Achilles tendonitis. To ensure
that the Achilles is not ruptured, doctors will often
ask the patient to try to rise up on the toes of the
injured leg, which is impossible if the tendon is not
at least partially intact.

Treatment
Achilles tendonitis can usually be treated without
surgery, using rest, anti-inflammatory medications,
and stretching exercises. Physical therapy and
orthotics for the shoes may also be needed.
Some patients, however, will require surgery.
Those with severe tendonosis may need to have
the degenerated portions of the tendon removed.
The surgery is then followed by a strenuous rehabilitation
program.

Prevention
Warming up before exercising and proper stretching
are essential to the prevention of Achilles tendonitis.
Avid runners should take precautions
against developing problems with the Achilles tendon
by not only stretching properly but also by
running on soft surfaces, wearing shoes with adequate
cushion, and making gradual changes in
mileage, speed, and terrain, as opposed to abrupt
and severe changes.
acromioclavicular (AC) joint injury Acromioclavicular