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Achilles Tendinitis and Achilles Tendon Ruptures

Symptoms of Achilles Tendinitis

Achilles tendinitis is an inflammation of the Achilles tendon “heel cord closed which inserts on the back of the heel. Symptoms include pain and swelling and there may be a feeling of stiffness. This pain and swelling may worsen with exercise, specifically the day after as the muscles in the leg tighten. However, some people will experience a decrease in pain with exercise and then an increase the next day. The tendon may feel like it has become thick and hardened. Those with insertional tendinitis may experience a bone spur development on the back of the heel. This condition occurs when there is calcification causing additional bone growth which rubs on the already inflamed tendon.

Diagnosis of Achilles tendinitis is made by taking a careful history of the pain and injury and performing a thorough physical examination. Radiographs or X-rays of the heel are necessary to determine any calcification or enlargement of the heel bone. An MRI will be utilized if the calcification is to the point that surgical intervention is necessary.

Types of Achilles Tendinitis

The Achilles tendon is the largest tendon in the body and connects the heel of your foot to your calf muscle. Tendinitis is caused when the tendon becomes inflamed from overuse. This inflammation in turn causes pain and swelling. The two types of tendinitis that occurs at the Achilles tendon are non-insertional and insertional. The difference is based on the location of the inflammation. Non-insertional tendinitis occurs at the middle of the tendon and is more typical in active and younger individuals. Insertional tendinitis involves the area of the tendon which connects to the heel bone. This type can also lead to bone spurs when left untreated. Aside from simple overuse, Achilles tendinitis can be caused by tight calf muscles, bone spurs in the heel or a dramatic increase of physical activity.

Treating Achilles Tendinitis

Initial treatment includes the RICE protocol of Rest, Ice, Compression, and Elevation. Anti-inflammatory medications may also be used to help control your pain and reduce inflammation. Physical therapy, involving strengthening and stretching the posterior muscles of the lower leg may be recommended. Orthotics, heel lifts or change in footwear may be recommended.
Severe tendinitis with high levels of calcification may require surgery. Surgery methods vary between lengthening of calf muscles, removal of the area that is damaged, repair of the tendon or tendon transfer.

Achilles Tendon Ruptures

Less common but more severe than tendinitis is a ruptured Achilles tendon. Symptoms of an Achilles tendon rupture include a sudden severe pain in the back of the calf or heel. It may feel as though you have been kicked or hit directly over the tendon. There is tenderness, pain, difficulty walking, weakness and often limping. There may be swelling, discoloration or bruising. He may be able to field defect in the tendon. Nonsurgical treatment includes casting in a position of plantar flexion (with the ankle pointed down away from the body). This may be enough to facilitate healing but it does have a reinjury rate of about 30%. Surgery to repair the tendon directly is also an option.