achilles tendon disorders

Modified/summarized from the following websites:
https://orthoinfo.aaos.org/en/diseases–conditions/achilles-tendinitis
https://orthoinfo.aaos.org/en/diseases–conditions/achilles-tendon-rupture-tear-video/

Achilles tendon

The Achilles tendon is the largest tendon in the body. It connects the calf muscle to the heel
bone and is a component in normal walking, climbing stairs, running, and jumping. The Achilles
tendon can withstand great stresses, but is prone to tendonitis which can occur with overuse
and degeneration.

Achilles Tendonitis

Defined as inflammation of a tendon. Inflammation is the body’s natural response to injury or
disease and can cause swelling, pain, or irritation.
Two types of Tendonitis
Non insertional tendonitis (above the heel bone)
Tendon fibers in the middle portion of the tendon break down with tiny tears
(degenerate), swell, and thicken. This type of tendonitis more commonly affects
younger, active patients.
Insertional tendonitis (at the heel bone)
Involves the lower portion of the tendon, at the heel bone where the tendon
attaches (inserts).
Damaged tendon fibers may calcify (harden).
Bone spurs (extra bone growth) often form with this type of Achilles tendonitis.
This type of tendonitis can occur at any time, even in patients that are not active.
However, this can also come from years of overuse (runners, sprinters).
Causes
No specific injury is required for tendonitis to occur. The problem typically results from
repeated stress to the tendon. These are some associated factors:
  • Sudden increase in amount or intensity of exercise or activity
  • Tight calf muscles
  • Bone spur at the heel
Symptoms
  • Pain and stiffness along the Achilles tendon in the morning
  • Pain at the tendon or back of heel that is worse with activity or contact with shoes
  • Pain the day after exercise
  • Thickening of the tendon
  • Bone spur
Swelling that is present constantly, worse throughout the day with activity
If you experience a sudden “pop” or feel like you have ruptured your achilles tendon
you should see your doctor immediately.
Tests
X-ray: Gives an image of the bones. Can show if there is calcification within the tendon
itself, at the insertion of the tendon, and if there is a bone spur present.
MRI: Gives an image of the bones, tendon, ligaments, and other soft tissues. Not
required for the diagnosis of Achilles tendonitis, but may be beneficial for surgical
planning if you and your doctor are considering this as a treatment option.
Treatment
Non-surgical: Provides pain relief in most cases, but may take several months for
symptoms to completely subside. Patients with symptoms for longer than 3 months may
take several months for treatment methods to take effect.
Rest. Decreasing or stopping activities that make your symptoms worse. Switching from
high-impact activity (running, jumping) to low impact activity (bicycle, swimming) will
put less stress on the Achilles tendon.
Ice. Placing ice on the most painful area (never directly contact ice with skin) can be
helpful throughout the day. Can be done for up to 20 minutes and should be stopped if
skin becomes numb.
Non-steroidal anti-inflammatory medication. Short-term use of drugs such as
Ibuprofen/naproxen can be helpful to reduce pain and swelling.
Exercise/Physical therapy. Calf stretching in addition to physical therapy have been
shown to be effective methods for treatment of insertional and non-insertional Achilles
tendonitis
Cortisone injection. Not recommended as they can cause tendon rupture (tear)
Supportive shoes/orthotics. Pain from insertional Achilles tendonitis can be relieved by
shoes with soft heel cups can reduce irritation. Heel lifts can also help take some strain
off of the tendon. If pain is severe, a walking boot may be recommended for a short
period of time to reduce inflammation.
Surgical: should be considered if pain does not improve after 6 months of nonsurgical
treatment. The type of surgery depends on the amount of damage to the tendon.
Specific surgical treatment should be tailored to your specific condition and discussed
with your doctor.

Achilles Tendon Rupture

Rupture: a complete tearing of the tendon fibers which leads the tendon unable to perform its
normal function.
Location: most tendon ruptures occur within the tendon itself, above the heel bone. Rarely, the
tendon can rupture at the attachment on the heel bone.
Common age groups: Between 30 and 50 years old, with most occurring while performing
sporting activity.
Mechanism/symptoms: most ruptures will occur during running/jogging/landing when the
tendon is abruptly pulled longer than what it is capable of. Some patients report a “pop” in the
back of their leg at the time of rupture. Common symptoms include pain, swelling, and
weakness after rupture. If you are concerned about Achilles tendon rupture, you should see a
doctor urgently.
Treatment: treatment options consist of non-surgical and surgical repair. The rehabilitation
process between non-surgical treatment and surgical repair are similar. Full rehabilitation from
time of injury is 9-12 months and some patients can see benefits thereafter.
ROC Express provides an excellent way to be evaluated promptly after injury and starting
appropriate treatment immediately.