Achilles tendon pain: causes, treatment and when to treat

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The tendons are very strong but not very flexible, and the Achilles tendon is no exception. This means that the Achilles tendon can only be stretched until it becomes inflamed (known as tendonitis) or ruptures.

What is the Achilles tendon?

The Achilles tendon is the largest tendon in the body. It connects the muscles of the calf (calf) and soleus of the lower leg with the heel bone of the foot.

An Achilles tendon disorder can cause discomfort ranging from mild ache, soreness, and stiffness to severe pain, especially when the foot is bent downward.

Illustration by Alexandra Gordon, Get Meds Info

Causes

It is important to become familiar with the various conditions that affect the Achilles tendon as they require special care and treatment, some of which are more urgent than others.

general

The two most common causes of Achilles tendon pain are Achilles tendonitis and Achilles tendon. While these conditions appear to be similar, they describe unique events, one more acute and the other more chronic.

Achilles tendonitis

Achilles tendonitis is an acute inflammatory injury of the Achilles tendon that most commonly affects athletes, especially runners, or people who play sports that require frequent starts and stops, such as tennis.

A prominent symptom of Achilles tendonitis is pain, which is often described as a burning sensation that worsens with physical activity. The location of the pain can vary: it can be felt closer to the lower part of the calf muscle, along the tendon, or underneath. near the calcaneus .

Along with the pain, there may be slight swelling and warmth in the Achilles tendon area, as well as morning stiffness in both the heel and calf, which is relieved when the person warms up and stretches the ankle and leg .

In addition to people who are active or suddenly starting or increasing their exercise regimen, not being able to warm up the calf muscles before exercise is another possible trigger for Achilles tendonitis. The stiffer the calf muscles, the stronger the tension on the Achilles tendon.

Exercising in worn out running shoes or running shoes that are not designed for use in aerobic exercise can also cause Achilles tendonitis, as can other factors:

  • Cold weather training
  • Foot misalignment or flat parking
  • Bad running
  • Leg length discrepancy

Another cause of Achilles tendonitis is the development of a bone build-up on the back of the ankle, either a bone spur from arthritis or a Haglund's deformity from wearing ill-fitting shoes . The buildup of bone can irritate the Achilles tendon and cause pain and inflammation.

The presence of conditions such as psoriasis , high blood pressure, and obesity (which puts pressure on the tendons) is also associated with an increased risk of Achilles tendonitis .

Rarely, a class of antibiotics called fluoroquinolones has been linked to tendonitis and Achilles tendon rupture (described below).

Achilles tendon tendonosis

Unlike Achilles tendonitis, which describes an acutely inflamed tendon, the Achilles tendon describes a chronic degenerative tendon that results from untreated tendonitis. In the Achilles tendon, the collagen fibers that make up the tendon are destroyed or destroyed. This deterioration not only causes pain in the tendons, but also the formation of scar tissue, which can lead to irreversible thickening .

The tricky part is that while Achilles tendonitis inflammation can be alleviated with proper treatment and heal well, some cases are not painful, so the person doesn't really know there is a problem until tendonitis develops. (where there is always pain). ..

Rare

Achilles tendon rupture, when the tendon fibers are torn and partially or completely separated, is rare.

Achilles tendon rupture

In order for the Achilles tendon to rupture, a sudden force is usually applied to the tendon, which often occurs during intense exercise that requires sudden rotation of the foot, such as playing basketball. However, even riding in a place where the foot is used to prevent a fall or stepping off a curb is sometimes enough to stretch and tear the tendon.

When the Achilles tendon ruptures, along with severe heel pain, some people hear a "pop" or "click" and there may be a visible tear at the site of the tear. Usually when a tendon ruptures, a person cannot walk or carry a weight on the legs, although a small group of people can still do so.

When to contact a healthcare provider

If you feel pain in the back of your leg, from heel to calf, it is important to seek medical attention. Other symptoms that require a visit to your doctor include:

  • Stiffness or pain in the legs or ankles.
  • Swelling over the Achilles tendon
  • It's hard to tiptoe
  • Signs of infection such as redness or warmth around the ankle or leg.

If you develop symptoms that indicate a possible Achilles tendon rupture, such as sudden, severe pain in the back of the leg and / or trouble transferring weight to the leg, seek immediate medical attention.

Diagnostics

Achilles tendon pain is usually diagnosed clinically, which means that your healthcare provider will ask you questions about your pain and perform a physical exam. If a rupture is suspected, magnetic resonance imaging (MRI) or ultrasound is required.

Physical exam

A complete physical examination of the foot and ankle is perhaps the key to diagnosing the cause of Achilles tendon pain.

Some basic elements of the physical exam include examining and palpating (pressing) the area around the Achilles tendon for swelling, warmth, crepitus (popping sensation), and tenderness; All of these features may be present in acute Achilles tendonitis. In the Achilles tendon, in addition to tenderness in the tendon on palpation, the tendon may appear thickened or there may be slight irregularities along the tendon, indicating areas of scar tissue and fibrosis.

Sometimes a doctor can diagnose an Achilles tendon tear by feeling it. Another sign of an Achilles tendon rupture is a bruise over the tendon, especially if the blood runs below the ankle (the protruding bone at each ankle).

Thompson test

As part of a physical exam for Achilles tendon pain, your doctor will perform a Thompson test , also called a calf compression test. During this test, the person lies on the exam table with their feet dangling over the edge. The doctor will then tighten the calf muscle, which should bend the toes downward (this is called plantar flexion). If not, the Achilles tendon rupture test is positive.

Display

Chronic Achilles tendon symptoms are usually examined with an X-ray of the foot, which can reveal problems such as bone spurs or degeneration.

Ultrasound or MRI is used to make or confirm a diagnosis of an Achilles tendon rupture.

Differential diagnosis

When you see your doctor about Achilles tendon pain, your doctor will consider several other conditions. Some of the more common conditions include ankle sprain, stress fracture, or calcaneal bursitis (called calcaneal bursitis).

A bruise around the Achilles tendon can be seen with an ankle sprain or stress fracture, or with an Achilles tendon tear, so an X-ray is needed to distinguish between these conditions. With calcaneal bursitis, tenderness is usually palpable at the site of attachment of the tendon to the calcaneus. On the other hand, with Achilles tendonitis, the pain in the tendon is usually greater, between two and six centimeters above the insertion site.

Other conditions that can be considered include:

In these aforementioned cases, along with a complete physical examination, blood tests or imaging tests such as ultrasound or X-rays may be used to confirm the diagnosis.

For example, Doppler ultrasound can rule out the formation of a thrombus in the calf, and X-rays can reveal classic changes in ankle osteoarthritis.

Similarly, a person with rheumatoid arthritis will generally have elevated blood levels of anticyclic citrullinated peptide (anti-CCP) , along with other RA symptoms such as fatigue and joint pain.

If a healthcare professional is concerned about an infection of the heel bone or skin near the tendon, it is helpful to look for markers of inflammation (such as erythrocyte sedimentation rate) and / or an increase in the white blood cell count.

Watch out

There are many treatments for Achilles tendon pain, including changing physical activity, taking medication, physical therapy, and possibly surgery. The key to recovery and a good recovery is constant observation and adherence to treatment from start to finish. The end.

Self service

Self-help strategies can be used to treat Achilles tendonitis and help in the immediate treatment of a possible Achilles tendon rupture.

Reduce activity or rest

If you are diagnosed with Achilles tendonitis, you do not need to completely stop activity if you experience muscle pain and consequently decrease activity. Be sure to start light calf stretches after your workout while your muscles and tendons are still warm and flexible.

Rest is mandatory for the initial treatment of an Achilles tendon tear until you receive further guidance from your orthopedic surgeon.

Ice

For Achilles tendonitis, it may be helpful to apply ice at the onset of pain and after exercise.

If you suspect a rupture, be sure to ice the tendon and raise your leg on the way to the emergency room.

Support

In addition to reducing activity and icing, it is important for Achilles tendonitis to prevent the tendon from moving too much by wrapping an elastic band or tape around the ankle.

Similarly, an orthopedic surgeon will immobilize your ankle, often with a splint, until you undergo surgery for an Achilles tendon rupture.

Orthopedics

For Achilles tendonitis and tendinosis, braces can be used to correct misalignment of the foot (if, for example, flat feet are believed to cause or contribute to Achilles tendon pain). For those with Achilles tendonitis or tendinosis, orthotics with a heel lift can ease tendon tension and ease pain.

Medicine

To reduce pain from any Achilles tendon disorder, talk to your doctor about taking non-steroidal anti-inflammatory drugs (NSAIDs).

Despite common misconceptions, corticosteroid injections are not recommended for Achilles tendon pain.

Physiotherapy

For Achilles tendonitis, when your doctor thinks you are ready, it is recommended that you start with calf strengthening exercises. Calf raises, toe balancing, and wall stretching are helpful exercises. Eccentric strength training is also a popular and beneficial treatment option, as is deep friction massage of the calf muscles and soleus that attach to the Achilles tendon.

If you develop an Achilles tendon, it is important to speak with your doctor about a referral to a special rehabilitation program that focuses on a slow, progressive, high-resistance exercise regimen.

Instrumental soft tissue mobilization (IASTM) is an interesting technique that is sometimes used in the treatment of the Achilles tendon. This therapy works by using a tool to re-stimulate the inflammatory process in the body, which then triggers the formation of new collagen in the tendon.

For Achilles tendon rupture, surgery may be required and physical therapy is absolutely essential for a full recovery later, which can take three to six months.

Operation

A ruptured Achilles tendon sometimes requires surgery by an orthopedic surgeon a few days after the injury. During the operation, the two ends of the divided tendon are sutured together.

Note that a partial Achilles tendon tear is sometimes treated like the Achilles tendon (conservatively and non-surgically). The orthopedic surgeon will make this decision, which depends on several factors, including the severity of the rupture, your age, medical history, and your normal activity level.

Partial tendon tears are especially painful. Thus, if surgery is not performed, immobilization with controlled movement of the ankle is sometimes recommended, as well as physical therapy or home exercises to avoid loss of muscle strength in the foot and ankle.

Prophylaxis

The main cause of Achilles tendon problems is ignoring early warning signs and getting over the pain. That being said, if your Achilles tendon hurts or hurts, you need to pay attention and rest immediately.

Extension

Also, it is important to stretch before exercising to avoid injury to the Achilles tendon. Some basic stretching exercises include the following:

Aside from stretching, be sure to start slowly and then increase your pace; in other words, allow a good warm-up.

Strengthening

Some experts also believe that eccentric strengthening of the Achilles tendon, calf, and soleus muscles can reduce the risk of Achilles tendonitis and calf sprains .

Other

Other tips that can help prevent Achilles tendonitis include:

  • Always wear shoes that provide adequate heel cushioning and good arch support.
  • Avoid running on hard surfaces
  • Avoid exercising outdoors in cold weather.

Get the word of drug information

If you or your loved one is experiencing Achilles tendon pain, know that you are not alone; this is a common, albeit unpleasant condition. The good news is that with proper treatment, the vast majority of people get better. Even if your condition becomes chronic, a good rehab program should help you get back on track.

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