Achiles Tendonitis

Definition

Achilles tendon is a crucial tendon that plays a significant role when walking or running, and inflammation occurring in the sheath surrounding this tendon is referred to as Achilles tendonitis.

Symptoms

The area around the Achilles tendon becomes hot and swollen.
There is pain before and after exercise, and a sensation of stiffness.
There is a sound when moving the ankle.
There is pain in the Achilles tendon area when running or jumping.
Pain is felt when pressing 2-6 cm above the heel.

The Importance of Treatment

Ignoring the pain and missing the appropriate treatment window can lead to the risk of Achilles tendon rupture, so receiving timely treatment in the early stages is crucial.

Causes

Achilles tendonitis, which can occur frequently among athletes, as well as among individuals with professions that require prolonged standing, is not only associated with sports-related injuries. It can also develop due to inflammation caused by excessive walking without proper warm-up exercises or friction from the back of shoes. Additionally, it may occur as a result of factors such as a high arch in the foot or deformities in the heel.

Issues

The Achilles tendon is one of the most critical low-vascular regions in the human body, and when inflammation occurs in this area due to inadequate blood supply, it can rapidly worsen in a short period.

Achilles tendonitis, as time passes, can accelerate tendon damage due to inflammation, leading to degenerative changes. It is especially important to be cautious as it can become a cause of Achilles tendon rupture.

Chronic Achilles tendonitis is one of the most challenging conditions to treat among sports-related ailments. It is a condition that poses a significant threat to athletes and is often a primary reason for discontinuing sports activities. It commonly affects not only endurance athletes like marathon runners but also athletes participating in various team sports. When Achilles tendonitis becomes chronic, it means that inflammation has progressed not only in the sheath surrounding the tendon but also within the Achilles tendon itself.

One of the critical pathological factors of Achilles tendonitis is the vulnerability of the Achilles tendon itself, implying that the initial cause of inflammation lies within the tendon. The Achilles tendon, located 2-6 cm above the attachment point to the heel bone, is in a low vascular or poorly blood-supplied region known as the hypovascular or tendon avascular zone. Repeated trauma in this area can lead to microscopic partial tears in the tendon fibers, and with further progression, it can undergo degeneration, ultimately resulting in a rupture. It has been observed that Achilles tendonitis progresses to Achilles tendon rupture in approximately 15% of cases.

Chronic Achilles tendonitis can be suspected when there is swelling in the upper part of the Achilles tendon, which is the area just above the heel, along with tenderness and pain when pressure is applied. Signs such as pain changing as the ankle is moved up and down (Painful arc sign) should also raise strong suspicion of Achilles tendonitis. In such cases, confirmation can be obtained through tests like ultrasound and MRI to examine the interior of the Achilles tendon.

Treatment for Achilles Tendonitis

In the early stages of Achilles tendonitis, treatment involves resting from activities, taking anti-inflammatory medication to control inflammation and pain, and applying cold packs and massages. In cases of severe pain, temporary immobilization with a cast or brace may be necessary. Typically, symptoms improve within 1-2 weeks, but it’s essential to be cautious and avoid continuing strenuous exercise, as it can progress to chronic inflammation.

For cases that have progressed to tendonitis, along with medication, Achilles tendon stretching exercises are essential.

In most cases where tendonitis is not severe, about 80% or more of individuals experience improvement with medication and exercise therapy. If exercise therapy doesn’t lead to symptom improvement, shockwave therapy can sometimes be considered. However, when conservative treatments don’t yield positive results, surgical intervention may be contemplated. Surgical treatment may be necessary if imaging tests like MRI show severe degeneration of the Achilles tendon or the presence of partial tendon tears. In such cases, surgery involves removing the degenerated portion and reconnecting the Achilles tendon.

Achilles Tendon Stretching Exercises

One way to stretch the Achilles tendon is by standing on the edge of a step with the front part of your foot and lowering your heel below the step. Hold this position with the heel lowered for about 10 to 20 seconds and then come back up. Be sure to hold onto the handrail to avoid falling while doing this. It is recommended to perform this stretching exercise approximately 10 times in the morning and 20 to 30 times during meals later in the day. If this method is challenging, an alternative is to use a wall for support. Stand facing the wall, place both hands against it, and extend the affected foot behind you. While in this position, bend the front knee to stretch the Achilles tendon of the back leg. Ensure that the foot is in a dorsiflexed position for effective stretching.

Preventing Achilles Tendonitis

First and foremost, avoid overexertion during exercise. Prior to and after exercise, make sure to perform adequate stretching. Additionally, gradually increase the intensity of your workouts. If you experience pain after exercising, it’s advisable to rest until the pain subsides. Even for those who already have Achilles tendonitis, consistent stretching can help alleviate symptoms and prevent exacerbation.