Achilles tendinitis

The Achilles tendon is the strongest tendon in the human body, but can also be one of the most problematic. It is prone to degenerative and inflammatory disorders, as well as rupture. Degeneration of the Achilles tendon is known as ‘tendinosis’. Patients with this condition suffer with pain on activity, such as running, sports or climbing stairs, and may be quite disabled during flare-ups. There is often a tender swelling in the tendon, above the heel-bone, which, when severe, may indicate inflammation of the tendon sheath (‘Peritendinitis’). These conditions are collectively known as Non-insertional tendinopathy, as distinct from Insertional tendinopathy, when the pain and swelling occur near the heel bone.

Non-insertional Achilles tendinopathy

Non-insertional Achilles tendinopathy, otherwise known simply as ‘Achilles tendinitis’, often affects active people, particularly runners. Typical symptoms include pain in the tendon on running or walking, often associated with swelling. Patients often feel that they stiffen up at rest and during the night, and that the tendon has to ‘warm up’. The condition can be very difficult to treat, and often patients try many different treatments before seeking the advice of a specialist. A myriad of different treatments are available, but as with most things, it is best to stick to the tried and tested methods. Resting the tendon with heeled shoes or a heel-lift and a particular type of physiotherapy (eccentric calf strengthening) are usually all that is required. If your foot is unusually flat or high-arched, you may also require orthotics. The full course of treatment lasts three months and is effective in the majority of cases, even if symptoms have been long-standing. If not, other experimental treatments are sometimes appropriate. These include laser, ultrasound, electromagnetic frequency therapy, shock wave therapy or injection (own blood or sclerosant). Rarely, surgery may be indicated.

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These Achilles tendon problems are sometimes referred to as ‘injuries’, but strictly are ‘overuse’ or ‘chronic’ conditions. However, in certain circumstances, the tendon may rupture, either partially or completely.

Rupture of the Achilles tendon

Rupture of the Achilles tendon is becoming increasingly common, and usually occurs in middle age during ‘explosive’ sports such as squash, badminton or tennis. Typically a ‘pop’, ‘snap’ or ‘tear’ is felt behind the ankle, followed by bruising, swelling, pain and loss of function. Sometimes an Achilles rupture can be mistaken for a severe ankle sprain, because of the obvious similarities. The difference is that whereas an ankle sprain will usually heal well without any intervention, an Achilles rupture left untreated will usually result in a weak foot and a limp. It is therefore very important that you seek immediate advice from a specialist, if you suspect you have ruptured your Achilles. If seen at an early stage (within a few days), there are two options for treating a rupture – immobilisation or surgical repair. There are pros and cons of each form of treatment, and so treatment is tailored to the individual.

Non-operative treatment usually involves wearing a cast or boot with close monitoring over a 10 – 12 week period, followed by physiotherapy. Repair can be performed either open or ‘percutaneously’ (minimally-invasive), followed by a period of immobilisation and rehabilitation. The results of early treatment are usually very good. If the rupture is discovered three or more weeks after the injury, a more involved procedure (a reconstruction) may be necessary and, even after surgery, perfect function is rarely achieved.

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