If you have pain along the back of your leg near your heel, you may have Achilles tendonitis. Achilles tendonitis is an overuse injury that commonly occurs in runners and
?weekend warriors?. The Achilles tendon is the largest tendon in the body. Named after a tragic hero from Greek mythology, it connects your calf muscle to your heel bone to allow you to jump, run and
walk. Achilles tendonitis is most common in middle-aged men, but it can happen to anyone who has a sudden increase in physical activity. The risk is increased if you also have tight calf muscles
and/or a flat arch in your foot. Other risk factors include running in worn out shoes, cold weather, frequently running uphill or if you suffer from medical conditions such as diabetes or high blood
pressure. There are two main types of Achilles tendinitis: insertional and noninsertional. Insertional Achilles tendinitis involves the lower portion of the heel, where the tendon attaches to the
heel bone. Noninsertional Achilles tendinitis is when the fibers in the middle portion of the tendon have started to break down with tiny tears, swell, and/or thicken. This type is more often seen in
younger, active people. Both types can also cause bone spurs. Achilles tendonitis should be diagnosed by your doctor. However, if you experienced a sudden ?pop? in the back of your calf or heel, this
might be something more serious like a ruptured or torn Achilles tendon. If this happens, see your doctor immediately.
Short of a trauma, the primary cause of Achilles tendonitis is when the calf muscle is so tight that the heel is unable to come down to the ground placing extreme stress on the Achilles tendon at the
insertion. Keep in mind that the calf muscle is designed to contract up, lifting the heel bone off the ground, propelling you forwards to the front of the foot for push off. When the calf is so tight
that the heel is prevented from coming down on the ground there will be stress on the tendon and the foot will over pronate causing the Achilles tendon to twist, adding to the stress on the
insertion. Improper treatment may lead to a more severe injury, such as a rupture or chronic weakening, which may require surgery.
The onset of the symptoms of Achilles tendonitis tend to be gradual, with symptoms usually developing over a period of several days, or even weeks. Symptoms may include, Pain, this may be mild at
first and may only be noticeable after exercise. Over time the pain may become constant and severe. Stiffness, this is usually relieved by activity. Sluggishness in the leg. Tenderness, particularly
in the morning and most commonly felt just above where the tendon attaches to the heel bone. Swelling.
A podiatrist can usually make the diagnosis by clinical history and physical examination alone. Pain with touching or stretching the tendon is typical. There may also be a visible swelling to the
tendon. The patient frequently has difficulty plantarflexing (pushing down the ball of the foot and toes, like one would press on a gas pedal), particularly against resistance. In most cases X-rays
don't show much, as they tend to show bone more than soft tissues. But X-rays may show associated degeneration of the heel bone that is common with Achilles Tendon problems. For example, heel spurs,
calcification within the tendon, avulsion fractures, periostitis (a bruising of the outer covering of the bone) may all be seen on X-ray. In cases where we are uncertain as to the extent of the
damage to the tendon, though, an MRI scan may be necessary, which images the soft tissues better than X-rays. When the tendon is simply inflamed and not severely damaged, the problem may or may not
be visible on MRI. It depends upon the severity of the condition.
Treatment will focus on relieving the pain and preventing further injury. Your podiatrist may create shoe inserts or a soft cast to effectively immobilize the affected area for a period of time.
(Often, a couple of weeks are needed for the tendon to heal.) Medication can help too. Your podiatrist may recommend or prescribe oral medication.
Surgery for an Achilles tendon rupture can be done with a single large incision, which is called open surgery. Or it can be done with several small incisions. This is called percutaneous surgery. The
differences in age and activity levels of people who get surgery can make it hard to know if Achilles tendon surgery is effective. The success of your surgery can depend on, your surgeon's
experience. The type of surgery you have. How damaged the tendon is. How soon after rupture the surgery is done. How soon you start your rehab program after surgery. How well you follow your rehab
program. Talk to your surgeon about his or her surgical experience. Ask about his or her success rate with the technique that would best treat your condition.
Wear shoes that fit correctly and support your feet: Replace your running or exercise shoes before the padding or shock absorption wears out. Shock absorption greatly decreases as the treads on the
bottoms or sides of your shoes begin to wear down. You may need running shoes that give your foot more heel or arch support. You may need shoe inserts to keep your foot from rolling inward. Stretch
before you exercise: Always warm up your muscles and stretch gently before you exercise. Do cool down exercises when you are finished. This will loosen your muscles and decrease stress on your
Achilles tendon. Exercise the right way: If your tendinitis is caused by the way that you exercise, ask a trainer, coach, or your caregiver for help. They can teach you ways to train or exercise to
help prevent Achilles tendinitis. Do not run or exercise on uneven or hard surfaces. Instead, run on softer surfaces such as treadmills, rubber tracks, grass, or evenly packed dirt tracks.