Achilles Tendon

The largest tendon in the body which connects the calf muscles to the heel bone. It can handle forces of nearly 1,000 pounds. Despite this fact, it is also the most frequently ruptured tendon and is subject to a common overuse injury and inflammation both in professional and weekend athletes. This inflammation of the tendon is called Achilles tendonitis and is caused by the small tears in the tendon from overuse.

Achilles tendonitis attack is commonly triggered by the following events:

• Overuse, such as too much running, especially up or down hill.
• Trauma, such as a kick to the tendon.
• Lack of flexibility in calf muscles or insufficient stretching before exercise.
• Shoe pressure on the tendon or just above it.
• People who have been wearing high heels for a prolonged time may develop a shortened Achilles tendon and thus, are at highest risk of developing this condition.

Symptoms of Achilles tendinitis include:

• Gradually worsening pain after mild exercise.
• Pain, sometimes severe, along the tendon associated with running.
• Tenderness of the tendon or about an inch above it in the morning after night bed rest.
• Stiffness that’s relieved by stretching and warm-up.
• Swelling around the tendon with activity.

This diagnosis must be made by the orthopedic surgeon, because several conditions such as a partial tendon tear and heel bursitis have similar symptoms.

Treatment depends on the degree of injury to the tendon, but usually involves:

• Rest, which may mean stopping running or exercise for a week, or simply switching to a less stressful exercise, such as swimming.
• Nonsteroidal anti-inflammatory medication, such as aspirin or ibuprofen (Advil) to ease the pain.
• Icing of the tendon area several times a day for 20 to 30 minutes.
• Orthoses to help align the heel bone properly.
• Wearing of a restrictive bandage to help decrease tendon motion.
• Stretching, massage and exercises to strengthen the weak muscle group in front of the leg.
• Surgery is a last resort option. Some studies show that, without an operation, the tendon has a 38% chance of rupturing again. Some experts suggest surgery for active persons and nonsurgical treatment for elderly. Surgery helps to remove the thick fibrous tissue that develops over the tendon after continuous friction on the bone. Recovery is slow, may require a temporary cast and includes a rehabilitation program to avoid weakness. Surgical complications can include a scar, infection, and muscle atrophy.

Prevention:

• Choose your running shoes with sufficient cushion for the heel strike.
• Do not over-exercise.
• Walk and stretch to warm up gradually before running.
• Make sure you stretch the calf muscles.
• Increase your running distance and your speed gradually, in increments no greater than 10% a week.
• Avoid sudden strenuous sprinting, hill running.
• Cool down properly after exercise.