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Running Injuries: How to Beat Achilles Tendinitis

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Achilles Tendinitis is a very peculiar running injury but is also known to make an appearance among basketball players, dancers, or people in general who apply a lot of repeated stress on their feet. It can be a very painful condition. The Achilles Tendinitis is an overtime injury (like Shin Stress Fracture) that is caused due to a minor tear (or major rupture) of the Achilles tendon. The pain is similar to that of a hit or a kick in the back of the leg.

What is Achilles Tendinitis

If the Achilles tendon becomes painful, swollen or stiff due to overuse, it can lead to the condition known as Achilles Tendinitis. This condition is thought to be caused due to repeated tiny injuries, known as microtrauma, to the Achilles tendon.

Post each injury the complete healing of the tendon does not take place, which means that, over time, the damage to the Achilles tendon increases. If in future, this is not treated then it can lead to a chronic/ongoing condition that makes simply walking around almost impossible.

The uncompromising definition of the term tendonitis points towards an inflammatory condition of the tendon, but practically, few injuries are known to be solely due to inflammations.

Technically speaking, Achilles Tendinopathy is a broader term that involves a range of conditions which cause pain in the Achilles tendon. For example, it’s found that in the case of older athletes, the cause is mainly the degeneration of the tendon.

Causes of Achilles tendinitis:

  1. The use of incorrect or worn out shoes during exercising or running.
  2. Not performing proper warm up before an exercise.
  3. Incorporating intensity of exercise too quickly, like say, running speed or amount of distance covered.
  4. Introduction of hill running or stair climbing into an exercise routine prematurely.
  5. Running on hard or uneven surfaces.
  6. Any sudden intense physical activity. For instance, sprinting for the finish line.
  7. An injured calf muscle with little flexibility will increase the strain on the Achilles tendon
  8. A difference in the anatomy of the foot, leg, or ankle, such as flat feet or fallen arches could also lead to applying strain on the tendon.
  9. Extra bone growths or bone spurs where the tendon joins the bone, can rub against the Achilles tendon, causing damage and discomfort.

Just as an additional side note, patients who are taking fluoroquinolone antibiotics may have a higher risk of tendinitis and tendon rupture. The danger of injury is not erased completely when the dosage stops, and people have reported tendon problems even after several months of stopping the usage of drug.

Symptoms and Indicators of Achilles Tendinitis

Most cases of Achilles Tendinitis start out slowly with very little pain, leading to a gradual build-up of pain that worsens over time.

A person suffering from this condition will also notice the following:

  • The Achilles tendon will feel sore a few cm above where it meets the heel bone.
  • Some swelling or hard knots of tissue in the Achilles tendon.
  • The lower leg feels stiff, slow, or weak.
  • There is stiffness and tenderness in the heel, especially during the mornings, which gradually goes away.
  • A slight pain occurs in the back of the leg after running or exercising and becomes more severe.
  • Pain that intensifies when walking uphill, climbing stairs, or taking part in an intense or prolonged exercise.
  • The Achilles tendon shows signs of swelling or forms a bump.
  • The Achilles tendon creaks or crackles when the ankle is touched or moved or pressed.
  • The affected leg shows weakness.

There are many other similar symptoms show up in a number of conditions, therefore it is encouraged to seek medical advice for accurate diagnosis.

You can decide the grade of pain in your Achilles tendon using this table:

Grade of Pain

Description

1 (mild)

Pain post running only.

2 (moderate)

Pain prior to and post running; pain might show a gradual decrease during a run.

3 (severe)

Pain accompanying an activity; leading to decrease in volume of activity.

4 (extreme)

Pain during everyday activities; pain worsening or progressing.

 

 

 

 

 

 

Achilles tendinitis pain grades
Achilles Tendinitis Pain Grades

​​​​Anatomically Speaking: The Achilles Tendon

Anatomy of Achilles tendinitis
Location of the Achilles Tendon

The Achilles tendon is a large tendon at the back of the ankle. It is an extension of the gastrocnemius and soleus (calf muscles), running down the back of the lower leg attaching to the calcaneus (heel bone). The Achilles tendon affixes the leg muscles to the foot and gives the propensity to push off during walking and running.

Achilles Tendinitis and Other Conditions Defined

achilles tendinitis
Differences between the Various Tendon Conditions

There are various tendon conditions that can cause Achilles tendon pain. For ease of understanding we have explained them below in brief:

Tendonitis

Tendonitis is inflammation of the tendon. Achilles Tendinitis is usually an acute or a quick-onset condition which can last up to 6 weeks or less. Few practitioners diagnose this as the first in a continuum of tendon injuries that in due course increases in severity.

Tendinosis

Tendinosis is a non-inflammatory deterioration of the tendon, which typically materializes due to long-term overuse of the tendon, leading to weakening of the tendon fibers.

Paratenonitis

Paratenonitis is inflammation or swelling of the tissue that surrounds the tendon, which may thicken and adhere to the tendon. This diagnosis stands controversial, as many practitioners do not accept paratenonitis to be any different from tendonitis.

Insertional Achilles Tendinopathy

Insertional Achilles Tendinopathy is inflammation, and later, degradation of the tendon fibers that insert on the back of the heel bone/calcaneus. While many doctors describe these conditions as being a part of the spectrum of Achilles tendinopathy, others tend to use the term tendinopathy loosely to denote a tendon which fails to heal.

Anyone who has been diagnosed with Achilles tendinopathy is advised to inquire about the details of their condition.

difference between Achilles tendinitis and Insertional Achilles tendinitis
Non-Insertional vs. Insertional Achilles Tendnitis

Achilles tendinitis can advance in disparate ways. There are a few pointers that are easier to avoid than others, and being aware can aid in earlier diagnosis and help prevent serious injury.

Insertional Achilles tendonitis is not necessarily activity related. This condition will affect the lower portion of the tendon as it inserts into the heel bone.

Now, non-insertional Achilles tendonitis is more common among younger and more active people. In this case, the fibers in the middle of the tendon start to break down, thicken, and swell.

Insertional Achilles Tendinitis: Symptoms

  • The patient experiences a gradual onset of pain (without specific injury) on touch at the back of the ankle where the Achilles inserts.
  • Redness or swelling may also be seen.
  • The pain becomes more constant over time.
  • The pain worsens by any physical activity.
  • Tenderness can be felt directly over the back of the heel bone.
  • Often, a bone prominence (a lump) is formed in this area.
  • Movement of the ankle is limited by pain.

Diagnosis of Insertional Achilles Tendinitis

Clinical diagnosis involves X-rays and MRI. An X-ray of the affected area will show calcification deposits approximately 60% of the time. However, magnetic resonance imaging (MRI) is the more preferred choice because it can determine not only the extent of tendon degeneration but also other factors such as bursitis, another cause of posterior heel pain.

Home Treatment for Insertional Achilles Tendonitis

First and foremost, the aggravating factors, that is, loaded dorsiflexion movements, should be reduced immediately. To stop the condition from becoming chronic, the inflammation is treated with rest, ice compressions, NSAIDs (non-steroidal anti-inflammatory drugs), and isometric and eccentric exercises. It is important to not poke or rub the affected area and wear shoes that do not provide pressure over this area.

This must be combined with strengthening exercises for the calf muscles to improve tendon load capacity. 

Some chronic cases will require a more extensive rehab program. This involves functional strengthening, movement dysfunction correction, power training, plyometrics, and sports-specific rehab. The treatment option should be based on individual requirements recommended by a physiotherapist or health professional on detailed assessment.

How is Achilles Tendinitis Diagnosed

If you feel you are suffering from Achilles Tendinitis, get a check-up from your doctor before the situation worsens. Your doctor will ask you questions about the activities you've been doing and will examine your leg, foot, ankle, and knee for range of motion.

In case your pain is more severe, the doctor may check to see you haven’t ruptured or torn your Achilles tendon. In order to check this, the doctor will have you lay down face down, and bend your knee whilst pressing your calf muscles to see if the foot flexes. Any flexing of the foot will indicate that the tendon is at least partly intact.

They may also ask you to perform some other exercises to put some stress on your Achilles tendon. For instance, standing on the affected leg and raising your heel off the ground, or hopping on that foot whether on the spot or in a forward direction. These kinds of movement assist the diagnosis by bringing on or reproducing the pain.

achilles tendinitis x ray shot
Achilles Tendinosis: As Seen Through an X-ray (Source)

It's also a possibility that the doctor might order an X-ray or MRI scan of your foot and leg so as to check for fractures, partial tears of the tendon, or signs of a condition that might get worse. An X-ray will show whether the lower part of the Achilles tendon has calcified which is a clear denotation of Achilles tendonitis.

In the case of severe non-insertional Achilles Tendinitis, calcification can occur in the middle portion of the tendon as well. An MRI is not necessary for diagnosing the condition but it assists in showing the severity of the damage to the tendon and hence helps in planning for surgery.

Achilles Tendinitis Treatment

Treatment aims to relieve pain and reduce swelling. The possible course of action of the treatment will be conditional as per the severity of the condition and whether the patient is a professional athlete or not. The doctor will in all likelihood recommend a combination of strategies.

The prompt treatment of any soft tissue injury is composed of the RICE protocol which stands for – Rest, Ice, Compression, and Elevation.  This method should be followed for 48–72 hours. The main aim is to reduce the damage to the joint.

Another method is the No HARM protocol which is – No Heat, No Alcohol, No Running (or activity) and No Massage. This protocol will have similar effects of reducing the swelling in the injured area.

Methods of treating Achilles tendinitis include:

  • Application of Ice packs to the tendon, when in pain or after exercising, can diminish the pain and inflammation.
  • Resting gives the tissue time to heal. The type of rest would depend on the severity of the symptoms, in mild cases, it could mean reducing the intensity of a workout, but severe cases might require complete rest for days or weeks.
  • Elevating the foot above the level of the heart can reduce swelling.
  • Exercise, stretching and physical therapy taught by a therapist can improve flexibility and increase calf strength. This would also help the Achilles tendon to heal and prevent future injury. Physical therapy is mostly more effective for non-insertional Achilles tendinitis.
  • Pain relief via medications of the likes of non-steroidal, anti-inflammatory drugs - NSAIDS can reduce pain and swelling. However, people suffering from asthma, kidney disease, or liver diseases should first check with their doctor.
  • Steroid injections, like Cortisone, can reduce tendon swelling, but has also been associated with a greater risk of tendon rupture. What can reduce the risk is giving the injection while scanning the area with ultrasound.
  • Compression bandages and orthotic devices such as ankle supports, shoe inserts, and Achilles tendon braces can aid recovery as they take the stress off the tendon.
  • Extracorporeal shockwave therapy or ESWT is the use of high-energy shock waves to stimulate the healing process. While the results have not shown consistency, in case other measures fail, it’s worth a try before opting for surgery.

Also, do read about the Ankle Strengthening Exercises for Firm Ankles: A must for Runners

How Long Does Achilles Tendinitis Last

It usually takes a few days to 6 weeks or a month or two, for tendonitis to heal depending on the severity of the injury. About 1 in 4 people who have persevering pain have surgery to treat the condition.

Surgery would involve either of the following:
  • Discarding nodules or adhesions - parts of the fibers of the tendon that have stuck together, that have developed within the damaged tendon.
  • Making a lengthways cut in the tendon to help to invigorate and boost tendon healing.
  • While complications from surgery aren’t common, should they occur, can include issues with wound healing.

Post-Surgery Exercises for Recovery: How to Get Rid of Achilles Tendinitis Fast

After surgery, runners under treatment for Achilles tendinitis include exercises for recovery; it is recommended that a splint should be worn for two weeks in a toe-down position. This allows wound healing. After the wound begins to heal, weight-bearing in an Achilles tendinitis brace or cast in a toe-down position along with range-of-motion exercises are started.

Nitroglycerin patches to increase the blood supply to this area may also prove beneficial.

Preventive Measures

This condition cannot be completely prevented, but the dangers of developing it can be lowered by foreseeing the possible causes and taking precautions:

  • Create a variation in exercise methods to alternate between high impact exercises like running and low impact exercises like swimming which will reduce the stress on the tendon on some days.
  • Wear correct shoes that support the arch and protect the heel and replace them when worn out. (Check: When to Replace Running Shoes: A Quick Guide)
  • In case you have a shoe in good condition but doesn’t provide the necessary arch support, use artificial arch supports inside the shoe.
  • Gradually increase the intensity of a workout since Achilles Tendinitis can occur when the tendon suddenly undergoes too much strain.
  • Stretching and warming up helps to keep the Achilles tendon flexible, reducing the chances of tendonitis developing. Stretch every day, including on your rest days to further improve flexibility.
  • In most cases, change in lifestyle can help to improve symptoms. However, remember that symptoms could return if you do not restrict activities that induce pain, or if you do not sustain the power and flexibility of the tendon.

Summing Up

Achilles Tendinitis can affect anyone, but it’s a point to be noted that individuals with higher activity levels are more at risk, especially individuals who frequently partake of activities that include running and jumping. You could steer clear of Achilles tendon pain with the proper measures. Even if you encounter minor Achilles tendon pain, it is necessary to rehabilitate your injury and not continue to push yourself.

Repetitive action on an already painful Achilles tendon may lead to the rupture of the tendon, necessitating further medical intervention.

If you show any of the signs of Achilles Tendinitis it is best to reach out to a doctor at the earliest to discuss treatment options. They might be able to recommend small lifestyle changes, or in case of severe circumstances, interventional treatment options can be offered. Even if you do get Achilles Tendonitis, don’t get discouraged, get better, get up, and run again!

 

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