What is Achilles Tendinitis Pain

Touted as the strongest tendon in the body, the Achilles tendon connects the calf muscle, beginning around the mid-calf, to the posterior region of the heel bone, or the calcaneus. This tendon plays a key role in rising up on one’s toes and pushing off the ground when walking or running.
Though the phrase tendinitis is commonly used to describe conditions associated with the Achilles tendon, it is a misnomer. The term refers to inflammation of the tendon, however, this is very rarely the origin of Achilles tendon pain. Most commonly, Achilles tendinitis is characterized by a deterioration of the tendon, along with a disorganization of the tissue. Symptoms of this degeneration and disorganization typically include pain, ankle swelling, restricted range of motion, and some loss of strength. The pain associated with Achilles tendinitis can range from mild to severe, and may have a gradual or a sudden onset. Patients are likely to experience more ankle stiffness in the morning, as well as increases in pain severity with physical activity such as walking or running. Physical examination includes assessment of pain and degree of swelling. Your physician will likely have a number of questions regarding your history, the onset of the current episode of Achilles tendon pain, and a detailed description of the symptoms. Your physician may also palpate the tendon, which may exhibit an audible cracking.

Causes of Achilles Tendinitis

Achilles tendinitis is often described as having a sudden onset; however, evidence suggests a more gradual development of complications. Overuse is the most common cause of difficulties. It occurs when a proper warm-up routine is not completed before engaging in physical activity or a person starts new activity involving physical exertion after a significant period of time with little to no physical activity. Overload on the tendon leads to a non-inflammatory thickening of the tendon and an increase in tendon stiffness. Over time, if the overuse and overload of the tendon continues, the tendon will begin to become stressed leading to a disorganization of tendon tissue.
Finally, ongoing stress and overload to the Achilles tendon eventually leads to degeneration of the tendon, which characterizes tendinitis. Achilles tendinitis may affect anyone, however, individuals with higher activity levels are more at risk. In particular, individuals who frequently engage in activities that involve running and jumping characterize the population most at risk. Patients with chronic Achilles tendinitis are at risk for more serious complications.
More specifically, reoccurring degeneration and disorganization of the Achilles tendon can lead to small tears in the tendon, which may not heal completely causing the tendon to be weak and more susceptible to additional and more serious injuries. While overuse is a common cause of Achilles tendinitis, some genetic factors have also been identified as placing an individual more at risk for tendinitis. These factors include increasing age, being a male, and obesity. Individuals with previous difficulties with regard to the Achilles tendon are at risk for tendon rupture, which is a more serious condition requiring immediate medical attention.

Treatment for Achilles Tendinitis

Patients who present with more mild cases of Achilles tendinitis may successfully treat their condition with conservative interventions. Your physician may recommend rest, specified physical therapy exercises (such as stretches), and over-the-counter pain relievers that also are effective for reducing inflammation (nonsteroidal anti-inflammatory drugs. In cases of tendinitis that exhibit symptoms of swelling, it is recommended that the patient keep the affected ankle elevated. Application of a cold compress for 15 to 20 minutes is also recommended to reduce pain and swelling. Patients who are regularly involved in sports or exercise routines are strongly encouraged to allow ample time for full recovery. Full recovery may not be achieved for several weeks or even months. Though the patient may no longer be debilitated by symptoms of pain, stiffness, or weakness, the tendon may still not be fully healed. Chronic or persistent cases of tendinitis may require the use of a cast, brace, or boot that prevents movement of the foot and thereby protects the tendon from risk of stress or overuse during the healing process. Patients who are chronically debilitated by pain associated with tendinitis may be considered for steroid injections. For intraarticular injections, corticosteroids are injected directly into the tendon. Periarticular injections are not made directly into the tendon. Rather, corticosteroids are injected into the area surrounding the affected tendon. Patients are encouraged to discuss this treatment option in depth with their physician, as receiving injections has been found to increase the patient’s risk of future tendon rupture. Surgical intervention is a final option for cases that have not responded to other therapeutic techniques. Surgical intervention is always warranted in cases of tendon rupture.


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Conclusion

Achilles tendinitis is characterized by pain, stiffness, and swelling of the ankle. While many describe the etiology of the condition as following an acute event, it is likely that weakening and degeneration of the tendon developed over time as the result of overload. Individuals who engage in more frequent physical activity are at higher risk than those leading more sedentary lifestyles. Additionally, genetic factors have been linked with an individual’s increase in risk for developing Achilles tendinitis. A number of treatment options are available and are chosen according to the patient’s severity. It is recommended that you speak with your physician to develop an appropriate course of treatment.

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