tendonitis is inflammation and tendonosis is degeneration and irregular healing of the achilles tendon. The achilles tendon is the large tendon located in the back of the leg that inserts into the
heel. The pain caused by achilles tendonitis/osis can develop gradually without a history of trauma. The pain can be a shooting pain, burning pain, or even an extremely piercing pain. Achilles
tendonitis/osis should not be left untreated due to the danger that the tendon can become weak and rupture requiring surgery.
The calf is under a lot of strain when running: it is not only put on stretch during landing of the foot, but it also has to produce the tension needed to support body weight and absorb the shock of
landing. This is what is called an ?eccentric load?. Excessive eccentric loading - either by way of a dramatic increase in mileage, or excessive hill running, or faulty running posture - could very
well be the cause of a runner?s achilles tendinitis. The calf strain translates downward into the achilles tendon where it attaches to the heel, and inflammation ensues. Inflammation then causes
scarring and fibrosis of tissues, which in turn inflicts pain upon stretching or use. Risk factors for Achilles tendinitis also include spending prolonged amounts of time standing or walking.
Symptoms of acute achilles tendonitis will be a gradual onset of achilles pain at the back of the ankle, just above the heel bone. This may develop over a period of days. The achilles tendon may be
painful and stiff at the start of exercise and first thing in the morning. As the tendon warms up the pain will go often for it to return later in the day or towards the end of a prolonged training
session. The tendon will be very tender on palpation or pressing in on the achilles tendon or squeezing it from the sides. Chronic achilles tendonitis may follow on from acute achilles tendonitis if
it goes untreated or is not allowed sufficient rest. Chronic achilles tendonitis is a difficult condition to treat, particularly in older athletes who appear to suffer more often.
To confirm the diagnosis and consider what might be causing the problem, it?s important to see your doctor or a physiotherapist. Methods used to make a diagnosis may include, medical history,
including your exercise habits and footwear, physical examination, especially examining for thickness and tenderness of the Achilles tendon, tests that may include an x-ray of the foot, ultrasound
and occasionally blood tests (to test for an inflammatory condition), and an MRI scan of the tendon.
Treatment of Achilles tendonitis begins with resting the tendon to allow the inflammation to settle down. In more serious situations, adequate rest may require crutches or immobilization of the
ankle. Learn more about different treatments for Achilles tendonitis, including ice, medications, injections, and surgery.
Around 1 in 4 people who have persisting pain due to Achilles tendinopathy has surgery to treat the condition. Most people have a good result from surgery and their pain is relieved. Surgery involves
either of the following, removing nodules or adhesions (parts of the fibres of the tendon that have stuck together) that have developed within the damaged tendon. Making a lengthways cut in the
tendon to help to stimulate and encourage tendon healing. Complications from surgery are not common but, if they do occur, can include problems with wound healing.
Regardless of whether the Achilles injury is insertional or non-insertional, a great method for lessening stress on the Achilles tendon is flexor digitorum longus exercises. This muscle, which
originates along the back of the leg and attaches to the tips of the toes, lies deep to the Achilles. It works synergistically with the soleus muscle to decelerate the forward motion of the leg
before the heel leaves the ground during propulsion. This significantly lessens strain on the Achilles tendon as it decelerates elongation of the tendon. Many foot surgeons are aware of the
connection between flexor digitorum longus and the Achilles tendon-surgical lengthening of the Achilles (which is done to treat certain congenital problems) almost always results in developing hammer
toes as flexor digitorum longus attempts to do the job of the recently lengthened tendon. Finally, avoid having cortisone injected into either the bursa or tendon-doing so weakens the tendon as it
shifts production of collagen from type one to type three. In a recent study published in the Journal of Bone Joint Surgery(9), cortisone was shown to lower the stress necessary to rupture the
Achilles tendon, and was particularly dangerous when done on both sides, as it produced a systemic effect that further weakened the tendon.