Achilles tendonitis
Encyclopedia
Achilles tendonitis is tendonitis
of the Achilles tendon
, generally caused by overuse of the affected limb and is more common among athletes training in under less than ideal conditions. It should not be confused with xanthoma
of the tendon
, which is the accumulation of cholesterol
in patients with familial hypercholesterolemia
.
, cold compression therapy
, wearing heel pads to reduce the strain on the tendon, and an exercise routine designed to strengthen the tendon. Some people have reported vast improvement after applying light to medium compression around ankles and lower calf by wearing elastic bandages throughout the day. Using these elastic bandages while sleeping can reduce morning stiffness but care must be taken to apply very light compression during sleep. Compression accelerates healing by improving circulation. Seeing a professional for treatment as soon as possible is important, because this injury can lead to an Achilles tendon rupture
with continued overuse. Other treatments may include non-steroidal anti-inflammatory drug
s, such as ibuprofen, ultrasound therapy, manual therapy
techniques, a rehabilitation
program, and in rare cases, application of a plaster cast
. Steroid
injection is sometimes used, but must be done after very careful, expert consideration because it can increase the risk of tendon rupture[3]. There have recently been some interest in the use of autologous blood injections, however the results have not been highly encouraging and there is little evidence for its use[4]. However results over several years have shown that injection of saline deep to the tendon (High Volume injection) under ultrasound guidance carries a very high success rate and relatively rapid return to sport. [5] [6] This technique was pioneered by Otto Chan and Tom Crisp at London Independent Hospital. Severe cases may require surgery from an orthopedic surgeon or podiatric surgeon.
More specialised therapies include prolotherapy (sclerosant injection into the neovascularity) and extracorporeal shockwave therapy (ESWT). Efficacy and evidence for prolotherapy is limited.
can prescribe safe exercise methods.
Tendonitis
Tendinitis , meaning inflammation of a tendon , is a type of tendinopathy often confused with the more common tendinosis, which has similar symptoms but requires different treatment...
of the Achilles tendon
Achilles tendon
The Achilles tendon , also known as the calcaneal tendon or the tendo calcaneus, is a tendon of the posterior leg. It serves to attach the plantaris, gastrocnemius and soleus muscles to the calcaneus bone.- Anatomy :The Achilles is the tendonous extension of 3 muscles in the lower leg:...
, generally caused by overuse of the affected limb and is more common among athletes training in under less than ideal conditions. It should not be confused with xanthoma
Xanthoma
A xanthoma , from Greek xanthos, ξανθος, "yellow", is a deposition of yellowish cholesterol-rich material in tendons or other body parts in various disease states...
of the tendon
Tendon
A tendon is a tough band of fibrous connective tissue that usually connects muscle to bone and is capable of withstanding tension. Tendons are similar to ligaments and fasciae as they are all made of collagen except that ligaments join one bone to another bone, and fasciae connect muscles to other...
, which is the accumulation of cholesterol
Cholesterol
Cholesterol is a complex isoprenoid. Specifically, it is a waxy steroid of fat that is produced in the liver or intestines. It is used to produce hormones and cell membranes and is transported in the blood plasma of all mammals. It is an essential structural component of mammalian cell membranes...
in patients with familial hypercholesterolemia
Familial hypercholesterolemia
Familial hypercholesterolemia is a genetic disorder characterized by high cholesterol levels, specifically very high levels of low-density lipoprotein , in the blood and early cardiovascular disease...
.
Pathophysiology
The Achilles tendon does not have good blood supply or cell activity, so this injury can be slow to heal. The tendon receives nutrients from the tendon sheath or paratendon. When an injury occurs to the tendon, cells from surrounding structures migrate into the tendon to assist in repair. Some of these cells come from blood vessels that enter the tendon to provide direct blood flow to increase healing. With the blood vessels come nerve fibers. Researchers including Alfredson and his team in Sweden [7] believe these nerve fibers to be the cause of the pain - they injected local anaesthetic around the vessels and this decreased significantly the pain from the Achilles tendon.Treatment
Treatment is possible with iceIce
Ice is water frozen into the solid state. Usually ice is the phase known as ice Ih, which is the most abundant of the varying solid phases on the Earth's surface. It can appear transparent or opaque bluish-white color, depending on the presence of impurities or air inclusions...
, cold compression therapy
Cold compression therapy
Cold Compression Therapy combines two of the principles of R.I.C.E. to reduce pain and swelling from a sports or activity injury to soft tissues and recommended by orthopedic surgeons following surgery...
, wearing heel pads to reduce the strain on the tendon, and an exercise routine designed to strengthen the tendon. Some people have reported vast improvement after applying light to medium compression around ankles and lower calf by wearing elastic bandages throughout the day. Using these elastic bandages while sleeping can reduce morning stiffness but care must be taken to apply very light compression during sleep. Compression accelerates healing by improving circulation. Seeing a professional for treatment as soon as possible is important, because this injury can lead to an Achilles tendon rupture
Achilles tendon rupture
The Achilles tendon is the most commonly injured tendon. Rupture can occur while performing actions requiring explosive acceleration, such as pushing off or jumping...
with continued overuse. Other treatments may include non-steroidal anti-inflammatory drug
Non-steroidal anti-inflammatory drug
Nonsteroidal anti-inflammatory drugs, usually abbreviated to NSAIDs or NAIDs, but also referred to as nonsteroidal anti-inflammatory agents/analgesics or nonsteroidal Anti-inflammatory medicines , are drugs with analgesic and antipyretic effects and which have, in higher doses, anti-inflammatory...
s, such as ibuprofen, ultrasound therapy, manual therapy
Manual therapy
Manual therapy, manipulative therapy, or manual & manipulative therapy is a physical treatment primarily used by physiotherapists, chiropractors, osteopaths to treat musculoskeletal pain and disability; it most commonly includes massage therapy, joint mobilization and joint...
techniques, a rehabilitation
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
program, and in rare cases, application of a plaster cast
Orthopedic cast
An orthopedic cast, body cast or surgical cast, is a shell, frequently made from plaster, encasing a limb to hold a broken bone in place until healing is confirmed...
. Steroid
Steroid
A steroid is a type of organic compound that contains a characteristic arrangement of four cycloalkane rings that are joined to each other. Examples of steroids include the dietary fat cholesterol, the sex hormones estradiol and testosterone, and the anti-inflammatory drug dexamethasone.The core...
injection is sometimes used, but must be done after very careful, expert consideration because it can increase the risk of tendon rupture[3]. There have recently been some interest in the use of autologous blood injections, however the results have not been highly encouraging and there is little evidence for its use[4]. However results over several years have shown that injection of saline deep to the tendon (High Volume injection) under ultrasound guidance carries a very high success rate and relatively rapid return to sport. [5] [6] This technique was pioneered by Otto Chan and Tom Crisp at London Independent Hospital. Severe cases may require surgery from an orthopedic surgeon or podiatric surgeon.
More specialised therapies include prolotherapy (sclerosant injection into the neovascularity) and extracorporeal shockwave therapy (ESWT). Efficacy and evidence for prolotherapy is limited.
Prevention
Prevention includes following appropriate exercise habits and wearing low-heeled shoes. A physical therapist or athletic trainerAthletic trainer
An athletic trainer is a certified, health care professional who practices in the field of sports medicine. Athletic training has been recognized by the American Medical Association as an allied health care profession since 1990....
can prescribe safe exercise methods.