Achilles Tendonitis Treatment
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CAUSES
The achilles tendon is one of the only muscles to cross three (3) joints in the human body including the knee, ankle and subtalar joints. The achilles is one of the strongest muscles in the lower extremity and helps with lifting the heel off the ground when walking and jumping thereby propelling the foot downwards and forwards. This constant pull of the muscle may lead to an overuse syndrome causing strains, sprains and tears in the tissue which lead to pain and swelling in the area. The palpable cord area in the back of the heel is known as the watershed area and can become inflamed with a nodule forming from micro tearing of the tissue. There is also achilles tendon pain at the level of the insertion point on the back of the heel bone called the calcaneus which may or may not have a large bump associated with it known as a haglunds deformity. Most commonly seen in runners, weight lifters or even children whose growth plates are not closed yet (severs disease), this condition can also occur due to inactivity with sudden bursts of exertion in sedentary people.
DIAGNOSIS
Patients who suffer from achilles tendon pain most commonly relate an instance when they first felt the pain from running, exercise, shoe gear or just getting up one day and feeling a sharp pain in the back of the heel. Runners will slow there activity due to the pain and most people will state they hurt whenever trying to get up and walk. Diagnosis is made by palpating the achilles tendon cord and insertion site and eliciting pain. X-rays will be used to determine if there is any spurring or calcification of the achilles tendon. Diagnostic ultrasound is also used to measure the thickness and color of the tendon and to determine if there is any tearing in the tissues. An mri may also be recommended to check for the level and degree of damage to the tissue.
TREATMENT
Most commmonly conservative treatment for achilles tendon pain begins with stretching exercises, heel lifts, arch supports, icing, anti-inflammatory creams and steroid injectons to break the pain cycle and decrease the inflammation so the patient is able to stretch comfortably to help increase the range of motion of the muscle. If any or all conservative measures do not resolve the heel pain we at Mofas do not recommend an open procedure for achilles tendon repair. We highly recommend extracorporeal shock wave therapy (ESWT) as described in the heel pain section to help break up the calcifications and intiate blood flow which will decrease the pain and swelling and get the patient back to their normal routines sooner. With the open surgery procedure you are non weight bearing for 4-6 weeks and off work for 3-4 months. With the high intensity shock wave therapy (ESWT) procedure we recommend 3 days off work to allow the inflammatory process to take effect and then slowly increase your level of activity over a period of a month. You are in your shoes the same day full weight bearing and walking with little to no pain.
