tendonitis is commonly seen in athletes who sustain an increase in training load, and is most often due to overuse. Tendons respond poorly to overuse, therefore healing is slow. This can leave a
tendon pathologically defective, which decreases tendon strength and leaves it less able to tolerate load, thus vulnerable to further injury or tendinosis. Extrinsic factors contributing to this
condition include training errors and inappropriate footwear. Intrinsic factors include inflexibility, weakness and malalignment. In other situations, there will be clinical inflammation, but
objective pathologic evidence for cellular inflammation is lacking, and in these conditions the term tendinosis is more appropriate. Tendinosis is a degeneration of the tendon?s collagen in response
to chronic overuse; when overuse is continued without giving the tendon time to heal and rest, such as with repetitive strain injury, tendinosis results. Even tiny movements, such as clicking a
mouse, can cause tendinosis, when done repeatedly.
Over-pronation, injury and overstresses of the tendon are some of the most common causes. Risk factors include tight heel cords, poor foot alignment, and recent changes in activities or shoes. During
a normal gait cycle, the upper and lower leg rotate in unison (i.e. internally during pronation and externally during supination). However, when a person over-pronates, the lower leg is locked into
the foot and therefore continues to rotate internally past the end of the contact phase while the femur begins to rotate externally at the beginning of midstance. The Gastrocnemius muscle is attached
to the upper leg and rotates externally while the Soleus muscle is attached to the lower leg and rotates internally during pronation. The resulting counter rotation of the upper and lower leg causes
a shearing force to occur in the Achilles tendon. This counter rotation twists the tendon at its weakest area, namely the Achilles tendon itself, and causes the inflammation. Since the tendon is
avascular, once inflammation sets in, it tends to be chronic.
People with Achilles tendinitis may experience pain during and after exercising. Running and jumping activities become painful and difficult. Symptoms include stiffness and pain in the back of the
ankle when pushing off the ball of the foot. For patients with chronic tendinitis (longer than six weeks), x-rays may reveal calcification (hardening of the tissue) in the tendon. Chronic tendinitis
can result in a breakdown of the tendon, or tendinosis, which weakens the tendon and may cause a rupture.
If Achilles tendonitis is suspected, avoid any exercise or activity that causes the pain. It is advisable to see a doctor promptly so that an accurate diagnosis can be made and appropriate treatment
recommended. The doctor will take a full medical history and will ask about the nature and duration of the symptoms. They will perform a physical examination of the affected area. Ultrasound scanning
may be used to assess damage to the tendon or surrounding structures. Occasionally MRI (magnetic resonance imaging) may be recommended. The symptoms of Achilles tendonitis are often similar to
symptoms of other conditions such as partial Achilles tendon rupture and heel bursitis. This can make diagnosis difficult and a referral to an orthopaedic specialist may be required in order for an
accurate diagnosis to be made.
Tendinitis usually responds well to self-care measures. But if your signs and symptoms are severe or persistent, your doctor might suggest other treatment options. If over-the-counter pain
medications - such as ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve) - aren't enough, your doctor might prescribe stronger medications to reduce inflammation and relieve pain. A physical
therapist might suggest some of the following treatment options. Exercises. Therapists often prescribe specific stretching and strengthening exercises to promote healing and strengthening of the
Achilles tendon and its supporting structures. Orthotic devices. A shoe insert or wedge that slightly elevates your heel can relieve strain on the tendon and provide a cushion that lessens the amount
of force exerted on your Achilles tendon.
If non-surgical treatment fails to cure the condition then surgery can be considered. This is more likely to be the case if the pain has been present for six months or more. The nature of the surgery
depends if you have insertional, or non-insertional disease. In non-insertional tendonosis the damaged tendon is thinned and cleaned. The damage is then repaired. If there is extensive damage one of
the tendons which moves your big toe (the flexor hallucis longus) may be used to reinforce the damaged Achilles tendon. In insertional tendonosis there is often rubbing of the tendon by a prominent
part of the heel bone. This bone is removed. In removing the bone the attachment of the tendon to the bone may be weakened. In these cases the attachment of the tendon to the bone may need to be
reinforced with sutures and bone anchors.
Maintaining strength and flexibility in the muscles of the calf will help reduce the risk of tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis.