Achilles Tendonitis

The Achilles tendon, the largest tendon in the human body, is the fibrous connective tissue that links the gastrocnemius (calf muscle) to the calcaneus (heel bone) in the lower leg. This structure is essential to the efficient movement of the leg in walking, running or jumping, as the tendon maintains the stability of the leg when the calf muscle contracts, in conjunction with the flexor muscles of the foot, to generate the power necessary to move. Achilles tendonitis is the inflammation that occurs between the tendon and the sheath in which it is encased, primarily through overuse, in combination with factors such as an improper or incomplete warm up prior to an activity, a misalignment of the heel, or structural weaknesses such as a lack of flexibility in the calf or foot muscles.

As opposed to a rupture of the Achilles tendon, which is a completely incapacitating injury for an athlete, tendonitis may persist for a period of time. It is possible to continue with athletic activities while suffering from Achilles tendonitis; however, this injury can progress to a rupture, and it will inevitably cause significant discomfort, with resultant loss of function and range of movement, unless properly treated.

An Achilles tendonitis condition may be caused or further aggravated by an increase in either the intensity or duration of running workouts, a sudden introduction of either hill training or a stair-climbing program, an overly intense return to training after an absence or a layoff, a traumatic force applied to the tendon, either through a sudden, explosive movement such as a sprint start, or a jump in basketball.

There are a number of sports in which the participants are particularly prone to Achilles tendonitis. Running, both on the track and on the road, exposes a participant to such risk; cross country running, with its emphasis on trails and natural surfaces, places less stress upon the tendon. Sports requiring quick, explosive movement such as basketball and American football have a significant incidence of Achilles tendonitis.

Physical discomfort is a part of athletic activities, especially at an elite level. The distinction between the inherent discomfort of training or competition, and pain generated as a signal from the body that it has sustained an injury to a component part, is often a difficult assessment for an athlete. The diagnosis and subsequent treatment of Achilles tendonitis are often problematic for this reason. A mild pain that persists after training, a lack of vigor and explosiveness in running, and a slight swelling and tenderness experienced 1.1-1.9 in (3-5 cm) above the heel are the symptoms of Achilles tendonitis. Such symptoms may arise intermittently, or they may persist on a daily basis, for a period of months or years.

The treatment of Achilles tendonitis will vary depending upon the severity of the condition, and the treatment regimen will typically consist of one or more of the following components:

• A rest period of from 7 to 10 days will often be recommended. The athlete does not participate in any running or jumping in this period. Athletes will often engage in swimming as a way of maintaining fitness during their recovery from tendonitis, as swimming movements do not place stress on the tendon.
• Nonsteroidal anti-inflammatory medications, of which aspirin and ibuprofen are well-known examples, do not cure tendonitis, but are intended to assist with the management of pain and inflammation, in conjunction with other treatment.
• An orthotic device designed and custom fitted to correct misalignments in the lower leg that may contribute to tendonitis may be prescribed.
• A compression type bandage may be worn to support the tendon and to restrict its movement.
• Ultrasound treatment, the direction of high frequency waves into the injured tendon, can be employed. The generation of such waves creates a warming of the damaged tissue, which in turn increases blood flow and facilitates healing.
• Acupuncture has been employed to reduce discomfort and to facilitate healing in persistent cases.
• Stretching exercises, designed to increase the strength and the flexibility of the quadriceps (upper thigh muscle) and calf and muscles of the upper foot, to create a better balanced, more harmonious leg function.

The precautions to be followed by an athlete upon a return from Achilles tendonitis are similar to those required where the tendon is ruptured. The footwear to be used for sport must be in good condition, with special attention paid to the cushioning provided in the heel. A thorough warm-up, with a focus on the stretching of the tendon, and corresponding cool-down are of prime importance, as is a gradual, and not sudden increase in both training intensity or distances.

SEE ALSO Ankle anatomy and physiology; Athletic shoes; Lower leg injuries; Tendinitis and ruptured tendons.