Achilles tendinitis

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Achilles tendinitis is an inflammation of the tendon including all pains in the Achilles tendon. It commonly affects all athletes, but most particularly runners and joggers, usually resulting from a too high training volume and aggravated by micro-traumas due to shoe-ground interface.

Why is the Achilles tendon so fragile?

The Achilles tendon is the thickest and strongest tendon in the human body.

The Achilles tendon is at the end of the triceps surae,that includes the soleus muscle and the two gastocnemius muscles (calf muscles). It is the major plantar flexor, but also acts as an adductor and internal rotator of the foot

Tendons are made from fibrous cells connecting the fleshy body of the triceps to the calcaneum (bone) insertion. This tendon is rich in blood vessels and also has a large number of nerve endings, which explains why it is so sensitive.

How to recognize an Achilles Tendinitis?

The pain:

  • Chronic, occurring after a workout or a competition.

  • Chronic and gradual, after a series of repeated efforts, where the tendon attaches (insertion) to the base of the calcaneum, or to the whole tendon with possible local swelling with the growth of a nodule.

  • Chronic in the morning, then gradually disappears (morning limbering)

  • Acute due to micro-ruptures, but no complete rupture, of the tendon with a scraping sensation, like sandpaper

The main causes of tendinitis

1 - The physiological cause: weakened tendon resulting from overuse

Elasticity is the first property of this tendon, but it decreases with age.

We grow in strength as we lose in elasticity throughout our lives, which is why we need to do regular stretching. However, this key property of the tendon decreases faster than muscle elasticity.  It explains why the tendon weakens as we age. With age, the tendon loses its flexibility and stress resistance, and can therefore get inflamed, leading to tendinitis.

2- The many medical, technical and athletic causes

  • Overtraining and repeating the same sport gesture
  • Inappropriate running technique
  • Excessive eccentric contractions
  • Change in training routine
  • Frequent changes in training surface
  • Continually running on hard surfaces
  • Abnormal shoe wear
  • Plantar statics disorder: high arches or flat feet
  • Lack of stretching after sports
  • Poor diet, too acidifying
  • Diet that is too rich in proteins
  • Poor dental health
  • Inappropriate hydration
  • Metabolic disorder and excess weight
  • Drug intake, most particularly antibiotics
  • inflammatory rheumatic diseases.

Tendinitis diagnosis

Your doctor will perform an etiological assessment (determination of causes), a comparative physical exam and possibly a blood and dental check-up.

Then additional tests:

  • Muscle-tendon ultrasound,
  • IRM scan, if needed to identify the related causes and rule out partial rupture
  • Postural and podiatric check-up.

Treatments

Many treatments are available to manage Achilles tendinitis.

Only your doctor can prescribe the best treatment for the type of tendinitis you experience.

Every case is specific, and your doctor will select from the many treatments as listed below:

  • Remove the cause through partial or complete rest
  • Icing: this is an essential treatment. Ice should be applied either as an ice bladder or as a cold pack, or even direct icing, and used to massage the painful area. For optimal efficiency, the ice must cool the tendon, and therefore should be applied at least 10 minutes every morning and evening. Please note: cold may burn the skin: do not apply the ice directly to your skin
  • Deep transverse friction massages (DTF) : these very specific massages are truly part of the treatment of choice for tendinitis. Your physiologist will insist on the painful points you feel, massaging theses points with the thumb with small precise movements, for as long as 2 to 6 minutes on the most painful areas. These massages may be repeated 3 or 4 times during the week.
  • Physical therapy or electrotherapy-physiotherapy
  • Local anti-inflammatory drugs
  • General treatments: allopathy, homeopathy, herbal medicine
  • mesotherapy
  • infiltrations and other types of injections including PRP injectionshttp://www.irbms.com/prp-et-tendinopathies-membre-inferieur
  • Specific and general osteopathy
  • extracorporeal shock waves
  • using a heelpiece
  • Splint if needed
  • Postural rebalancing
  • Specific food diet
  • If it fails, surgery may be required

Back to sports

As soon as the pain is gone and after eliminating the cause.

The return should be gradual and essentially include training, to "test" the tendon.

Supportive strapping or restraint may be useful for safer return.

Advice from an IRBMS professional: Before going back to sports, have an assessment performed by a sport podiatrist to know which type of shoes to buy and possibly wear orthopaedic insoles.  Remember to drink on a regular basis because the Achilles tendon is very sensitive to dehydration

You need to warm up and start your workout gradually, and do some stretching, repeated mostly after your workout.

Remember that applying ice after exercise is often beneficial 

Conclusion

Achilles tendinitis is common and can affect all athletes.

The best prevention requires knowledge of the risk factors

Don't push on a painful Achilles tendon

 

Docteur Patrick Bacquaert

Médecin chef de l'IRBMS

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