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Heel Pain, Swelling Or Tenderness? You Could Be Suffering From Achilles Tendonitis
Foot & Ankle Specialist of the Mid-Atlantic

Heel Pain, Swelling Or Tenderness? You Could Be Suffering From Achilles Tendonitis

The Achilles tendon is the thickest and strongest tendon in the body. It is made up of the common tendon of the gastrocnemius and the soleus muscles that eventually form a common tendon, which inserts into the heel bone. Achilles tendonitis is defined as the symptomatic degeneration of the Achilles tendon with an interruption of blood supply and accompanied with an inflammatory response.

Achilles tendinitis most commonly occurs in runners who have suddenly increased the intensity or duration of their runs. It's also common in middle-aged people who play sports, such as tennis or basketball, only on the weekends.

The pain associated with Achilles tendinitis typically begins as a mild ache in the back of the leg or above the heel after running or other sports activity. Episodes of more-severe pain may occur after prolonged running, stair climbing or sprinting.

You might also experience tenderness or stiffness, especially in the morning, which usually improves with mild activity.

Achilles tendonitis occurs as a result of damage to the structural units and blood supply of the tendon. Unlike most tendons in the body, the Achilles tendon does not possess a tendon sheath, rather it is encompassed by a paratenon which is highly vascular and sometimes referred to as a pseudosheath. Both the paratenon and Achilles tendon are subject to inflammatory processes.

Causes of Achilles tendonitis include mechanical and biomechanical deformities as well as direct trauma. Trauma can result from a sudden force or the result of repetitive micro trauma in which the fibers are stretched to the point of fatigue and eventually tear. Biomechanical stresses involving joints of the foot can lead to abnormal forces and irregular pull of the tendon. Lack of stretching before and after exercising can play a huge role in the mechanical stresses about the achilles tendon.

The treatment of Achilles tendonitis focuses primarily on the use of conservative, noninvasive, therapeutic modalities. Management should be directed towards the underlying etiology and also include control of inflammation, reduction of pain, rehabilitation of the muscle tendon unit, progressive return to normal strength and activity, and control of any biomechanical factors.

In the acute stage of any injury, rest, ice, compression and elevation (RICE) should be instituted. Modalities rendered in the acute stage of Achilles tendonitis can include immobilization such as casting, a body armor boot, in combination with anti-inflammatory and pain medication.

Chronic stage treatment can include heel lifts, physical therapy with ultrasound and muscle strengthening and proper stretching before and after exercising. Orthotic management is often indicated and extremely effective in controlling biomechanical deformities that may cause more stress to the tendon.

Lastly, surgical intervention may be needed to primarily repair any damaged areas and lend strength to the tendon itself.

To avoid risk of injury, a regiment of stretching the muscle tendon unit before and after exercising will greatly reduce the risk of tears or even rupture. When unsure of an injury to any body part, it is always best to rest that area and seek medical advice if necessary.

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