Achilles Tendon Disorders (Tendonitis and Tendonosis)

Description


Anyone who has read up on their Greek mythology knows that an Achilles Heel
isn’t necessarily a good spot to rely on. However, most of us rely on our
Achilles tendon to a tremendous degree: we use it when jumping, running,
walking – pretty much any time we use our foot. Despite its mythological
association with weakness, the Achilles tendon (a thick, cord-like bunch of
tissue that attaches the calf muscle to the back of the heel bone) is
actually the strongest and largest tendon in the body. Unfortunately, it’s
also susceptible to injury, since the muscles that pull on it exert more
force than any other in the leg. To make matters worse, blood circulation
to the tendon is relatively poor, which means that it generally isn’t able
to heal quickly when injured.

Injuries tend to happen to the Achilles tendon when we overuse it,
resulting in inflammation (aka tendonitis). This can happen most frequently
with individuals whose activity suddenly increases or changes, such as
those who are active only on weekends or who suddenly become active (yes,
we’re looking at you, weekend warriors). However, tendonitis may also
result from putting consistent strain on the Achilles tendon. Athletes
(particularly those involved in running or jumping sports), or those whose
jobs cause them to overuse their feet or ankles will likely be the ones to
fall into this category.

Age may also play a factor, since tendons tend to lose flexibility as a
person grows older. The tendon’s inflexibility may also be exacerbated by
the wearing of high-heeled shoes, which can cause the tendon to be
shortened. Fortunately, stretching properly before exercising or engaging
in periods of high activity may help to reduce the chance of injuring your
Achilles tendon. (And you thought stretching was useless, didn’t you?)

Over time, if the tendon is misused enough, it gets pretty messed up.
Achilles tendonitis may progress to Achilles tendonosis, or full-on
degeneration of the tendon, in which it becomes more likely to experience
tears or, in rare cases, a rupture (which is not a pretty injury). Tearing
that comes with the tendonosis is usually microscopic (except in the case
of a rupture, of course) and tends to show up about 2 inches (or 6 cm)
above where the tendon is inserted into the heel bone.

Symptoms

If you have the misfortune of developing Achilles tendonitis or tendonosis,
you’ll likely notice swelling, tenderness, and warmth on the Achilles
tendon, or sometimes on your leg above the heel, anywhere from the back of
the heel to the bottom of the calf muscle. You may also be able to feel
with your finger, or even notice visually that your tendon has gotten
thick. Walking will probably be uncomfortable and somewhat difficult, since
your tendon will be painful and weak, and if the problem is severe enough,
it might completely prevent you from running around. Squeezing the sides of
the tendon is likely to be quite painful, although oddly enough, pushing on
the back of the tendon will be less painful.

When the tendonitis progresses to tendonosis, the symptoms will be more
severe. The tendon will become even more enlarged, with funky little
nodules in the damaged areas.

Diagnosis

When you go in to see your podiatrist about your painful Achilles tendon,
he or she will likely feel the tendon to check for bumps, and will probably
push it to see where it hurts. (This may be uncomfortable for you, but it’s
necessary to determine what the problem is.) He or she may also observe and
ask questions as you walk or stand on your tiptoes, to see when the pain
occurs.

Because your podiatrist is awfully clever, he or she will likely be able to
diagnose Achilles tendonitis or tendonosis from a physical examination of
the area. However, to make sure the diagnosis is correct, X-rays may be
ordered to rule out arthritis or other causes of pain, and an MRI might be
necessary to check the area if a rupture or partial rupture is suspected.

Treatment

Treating Achilles tendon problems may mainly focus on reducing the
inflammation of the area, allowing the tendon time to heal without adding
to the injury it has already sustained. This will probably be best
accomplished by letting the area rest by immobilizing it, either by a cast
or a boot. You can also try putting ice on the tendon (on for 20 minutes,
off for 40 minutes), although for pity’s sake, wrap the ice in a thin
towel. You should never put ice right on your skin. (Seriously – you don’t
want to cause frostbite – just reduce the swelling.)

Your podiatrist may also suggest anti-inflammatory medications, such as
ibuprofen, or steroid treatments such as cortisone. Physical therapy might
be used to strengthen the muscles around the tendon and prevent further
injury, or used to soothe the tendon and accompanying inflammation by use
of ultrasound therapy or stretching, or it might simply consist of teaching
you how to use your foot properly during the activities you so love to do.
Like walking.

If these treatments don’t work, or if the injury to your tendon is severe
enough, then surgery might be the best option to help your Achilles tendon.
Your surgeon may remove the damaged part of the tendon and stitch together
the remaining healthy portions. If the injury is pretty severe, the surgeon
may have to grab a tendon from another part of your body in order to repair
the damaged area.