DESCRIPTION

Achilles Tendonitis is an inflammation of the Achilles Tendon. This tendon attaches the muscles in the calf of the leg to the back of the heel. The Achilles Tendon is a long and thick tendon, which moves our foot downward, so that the toes point to the ground (plantarflexion). This tendon can become inflamed due to the following causes: There are several factors that can cause achilles tendonitis. The most common causes are over-training and over-pronation. Over-pronation occurs in the walking process, when the arch collapses upon weight bearing, adding stress on the achilles tendon. Other factors that lead to achilles tendonitis are improper shoe selection or shoes that are too old, inadequate stretching prior to engaging in athletics, a short achilles tendon or tight calf muscle, direct trauma (injury) to the tendon, and calcaneal (heel bone) deformity.

TREATMENT

The first thing to do is to cut back your activity. If you are working out twice a day, change to once a day and take one or two days off per week. If you are working out every day cut back to every other day and decrease your mileage.
If you have achilles tendonitis you should incorporate a thorough stretching program to properly warm-up and lengthen the muscles. Stretching should be performed several times a day but should be light and should not reproduce pain. These stretching exercises should include specific stretches for both the gastroc and soleus muscles. Athletes should decrease the distance of their walk or run, apply ice after the activity and avoid any up hill climbs. Ice should also be used occasionally throughout the day.

Use of a night splint may be indicated to help in counteracting the shortening of the achilles tendon that occurs as you rest. A heel cup or heel cradle elevates the heel to reduce stress and pressure on the achilles tendon. The device should be made with light-weight, shock absorbing materials. An orthotic device can be used to control over-pronation, support the longitudinal arch, and reduce stress on the achilles tendon.

In office treatment would initially consist of the use of physical therapy modalities including electrical stimulation, ultrasound, and iontophoresis (local delivery of anti-inflammatory using electricity). Your sports medicine professional should also carefully check your shoes and make specific recommendations. Your physician, podiatrist, or physical therapist may be able to help control the excessive pronation by fitting you with custom foot orthotics or a heel lift as appropriate. You may also require use of NSAIDS (anti-inflammatory medication) at the discretion of your doctor.

In severe cases immobilization by casting or use of a “moon-boot” (rocker bottom solid immobilization boot) may be required, and in extreme cases surgical debridement and possibly tendon lengthening may be needed.