Overview
Achilles tendinosis (also known as Achilles tendinopathy) is a soreness and stiffness that comes on gradually and continues to worsen until treated. It is a common injury among middle and long distance runners. The severity of Achilles tendinosis can be broken down into four stages, each of which can be measured in terms of how the Achilles tendon feels during exercise, the amount of stiffness and creaking, and Achilles tendon?s soreness to the touch (the Achilles tendon pinch test). The four stages, or grades, are, No pain during exercise, but there is some discomfort in the morning when first getting out of bed. The stiffness and creaking go away after a few minutes and are fine the rest of the day. Lightly pinching the Achilles tendon with the forefinger and thumb in the morning or after exercise will probably indicate soreness. Pain during exercise or running, but performance is not affected. The stiffness and creaking continue to appear when first getting out of bed and continue to disappear shortly afterward. Lightly pinching the Achilles tendon with the forefinger and thumb in the morning or after exercise will indicate soreness. Pain during exercise or running that is detrimental to performance. The stiffness and creaking continue to appear when first getting out of bed, but may continue for some time and reappear at other points during the day. Lightly pinching the Achilles tendon with the forefinger and thumb in the morning or after exercise will indicate soreness. Hurts too much to exercise or run. The stiffness and creaking continue to appear when first getting out of bed, but may continue for most of the day. Lightly pinching the Achilles tendon with the forefinger and thumb at almost any time of day will indicate soreness.
Causes
There are hundreds of tendons scattered throughout our body, but it tends to be a small handful of specific tendons that cause problems. These tendons usually have an area of poor blood supply that leads to tissue damage and poor healing response. This area of a tendon that is prone to injury is called a “watershed zone,” an area when the blood supply to the tendon is weakest. In these watershed zones, they body has a hard time delivering oxygen and nutrients necessary for tendon healing, that’s why we see common tendon problems in the same parts of the body. Tendonitis is most often an overuse injury. Often people begin a new activity or exercise that causes the tendon to become irritated. Tendon problems are most common in the 40-60 year old age range. Tendons are not as elastic and forgiving as in younger individuals, yet bodies are still exerting with the same force. Occasionally, there is an anatomical cause for tendonitis. If the tendon does not have a smooth path to glide along, it will be more likely to become irritated and inflamed. In these unusual situations, surgical treatment may be necessary to realign the tendon.
Symptoms
A symptom is something the patient feels and reports, while a sign is something other people, such as a doctor, detect. For example, pain is a symptom, while a rash is a sign. The most typical symptom of Achilles tendinitis is a gradual buildup of pain that deteriorates with time. With Achilles tendinitis, the Achilles tendon may feel sore a few centimeters above where it meets the heel bone. Other possible signs and symptoms of Achilles tendinitis are, the Achilles tendon feels sore a few centimeters above where it meets the heel bone, lower leg feels stiff or lower leg feels slow and weak. Slight pain in the back of the leg that appears after running or exercising, and worsens, pain in the Achilles tendon that occurs while running or a couple of hours afterwards. Greater pain experienced when running fast (such as sprinting), for a long time (such as cross country), or even when climbing stairs. The Achilles tendon swells or forms a bump or the Achilles tendon creaks when touched or moved. Please note that these symptoms, and others similar can occur in other conditions, so for an accurate diagnosis, the patient would need to visit their doctor.
Diagnosis
The doctor will perform a physical exam. The doctor will look for tenderness along the tendon and pain in the area of the tendon when you stand on your toes. X-rays can help diagnose bone problems. An MRI scan may be done if your doctor is thinking about surgery or is worried about the tear in the Achilles tendon.
Nonsurgical Treatment
Treatment can range from cold compress and heel pads for minor cases, to physical rehabilitation, anti-inflammatory medicine, ultrasound therapy, and manual therapy. If you are a Michigan resident that suspects they have Achilles Tendinitis, please contact Dr. Young immediately; Achilles Tendinitis, if left untreated, can eventually result in an Achilles Tendon Rupture, which is a serious condition that is a partial or complete tear in the tendon. It can severely hinder walking and can be extremely painful and slow to recover.
Surgical Treatment
Surgery is considered the last resort. It is only recommended if all other treatment options have failed after at least six months. In this situation, badly damaged portions of the tendon may be removed. If the tendon has ruptured, surgery is necessary to re-attach the tendon. Rehabilitation, including stretching and strength exercises, is started soon after the surgery. In most cases, normal activities can be resumed after about 10 weeks. Return to competitive sport for some people may be delayed for about three to six months.
Prevention
There are several things you can do to reduce the risk of Achilles tendinitis, warm up every time before you exercise or play a sport. Switch up your exercises. Slowly increase the length and intensity of your workouts. Keep your muscles active and stay in shape all year-round. When you see symptoms of Achilles tendinitis, stop whatever activity you are doing and rest.
Margaretta Baribeau 