The Achilles tendon runs parallel to the shin bone at the back of the ankle. It starts at the heel bone and extends upward along the shin bone. It is the strongest tendon of our body. Achilles means strongest in Greek. Inflammation of this tendon is called Achilles tendinitis. It is the most common cause of back ankle pain.
This tendon functions to lift the heel bone up during walking and running. Standing, walking and running for long periods of time create excessive stress on the Achilles. In this case, tendinitis may result.
Definition
Simply defined, inflammation of the tendon is called tendinitis. Inflammation is swelling, pain and tenderness in our body where healthy tissues respond to overuse, injury or disease. Tendonitis in the middle of the Achilles tendon is generally degenerative, and that in its attachment points is due to overuse. Tendinitis in the middle is usually seen in young and active people.
It is most often seen where it attaches to the heel bone, calcification and bone spurs may occur. It is generally seen in older, inactive people.
Causes
There is no specific injury associated with Achilles tendinitis. The basis of the problem develops as a result of repetitive and overuse-related stress on the Achilles. Risk factors include excessive load on the body for a short period of time, rapid weight gain, standing for long periods of time, and using hard leather and flat-footed shoes.
Other reasons;
- Walking and standing for long periods of time and without condition
- A calf muscle with poor condition is usually stiff. Sudden and excessive exercise increases the load and stress on the Achilles.
- Spur development in the heel bones makes the Achilles sensitive.
Clinical Findings and Complaints
- Pain and stiffness along the Achilles tendon in the morning
- Increased pain and sensitivity where the Achilles tendon attaches to the heel with increased activity
- Pain throughout the day after exercise
- Thickening and swelling occurs
- If you hear a popping sound from the Achilles tendon, especially during sports activity, it may be ruptured. In this case, consult your doctor immediately.
Physician Examination and Diagnosis
After your physician discusses your complaints and medical history with you, He will examine the bee for clinical findings. The physician may request ultrasound, x-ray and MRI to be sure of the diagnosis.
X-ray shows bone spurs and calcifications well and helps in the differential diagnosis of bone diseases. MRI evaluates soft tissues such as the Achilles very clearly.
Treatment
Non-Surgical Treatment Methods
In many patients, surgery is required. Patients get relief with non-invasive methods. However, it may take a few months for complaints to be relieved. Even if diagnosed and treated early, it usually lasts more than 3 months. In severe pain, this period can take up to 6 months.
Rest:
This is the first stage and increased activity should be stopped. In particular, activities that worsen pain should be avoided. Sports such as running, which put excessive stress on the Achilles, should be stopped. Instead, you can continue sports that put low stress on the Achilles, such as swimming.
Ice Application
Ice application is very useful. Apply ice for 20 minutes every 1-2 hours throughout the day. Apply the ice over a towel. Special gel bags are available for application.
Medical Treatment
Nonsteroidal anti-inflammatory drugs can be used to reduce inflammation. However, it is not recommended for use for more than 1 month.
Exercise
Stretching exercises allow the calf muscle to lengthen and reduce the tension on the Achilles.
Do 10 exercises by pushing the wall while standing. hold for seconds and relax. Apply 20 times in a single session.
Physical Therapy
It is useful in healing the Achilles tendon. It is especially effective in mid-Achilles tendinitis.
Eccentric Stretching Protocol
With these exercises, calf and Achilles stretching is performed. It is an exercise performed by climbing stairs on the heel. It can be done with a soft heeled shoe. It may be a little painful, but it is very beneficial to do. It is done in a single session for 5 minutes and 3 sessions a day.
Local Steroid Injections
It is a very effective medicine. It is usually applied as a single dose or a maximum of 3 times. However, it is the last choice unless it is necessary.
Supportive Shoes and Orthoses
Shoes with soft soles and higher heels. These should be used. If the heel is high, Achilles tension is reduced. Especially the sole part should be flexible and work like a shock absorber. You should take a break from the leathery and hard sole.
ESWT
Inflammation is reduced by increasing regional blood flow with sound waves.
Surgical Treatment
In cases that do not respond to all treatments for 6 months, surgery is considered depending on the location of the tendonitis and the amount of damage.
Surgeries performed;
Lengthening surgery is performed on the gastrocnemius muscle to reduce Achilles tension. It is a beneficial surgery with a low rate of undesirable events.
Debridement: If there is less than 50% damage to the tendon, calcifications can be cleaned. Damaged areas are cleaned. Afterwards, boot or cast treatment can be performed.
Tendon Transfer: If the damage is more than 50%, tendon transfer is performed.
Healing: Many Successful results were achieved with the surgery in the patient. However, success varies depending on the amount and location of the damage. Relief from pain and recovery may take up to 12 months.
Complications: Constant pain may occur at a rate of 520-30. Another complication is infection.
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