Achilles tendinopathy or tendinitis of the heel is an injury condition to the muscle-tendon connecting calf muscles to the heel bone. It is usually caused by severe overload, blunt trauma, or muscle fatigue of the Achilles tendon. However, it is the strongest and largest of all human tendons and provides serious resistance to enormous tensile forces daily. But factors like decreased arterial blood circulation lowered nutrition, and a decline in metabolic activities can lead to chronic Achilles injuries due to overuse. The symptoms can be acute pain, stiffness of tendons, and inflammations. Here we will try to present a physio perspective into the causes, symptoms, and remedies for this overuse injury for your reference.
Aetiology And PreventionRisk factors that can contribute to Achilles tendinopathy injuries can include: Physical conditions like obesity, tight calves, and overpronated feet. Bad training habits like running with worn-out shoes or uneven terrain on cold feet. Medical conditions like high blood pressure, type II diabetes, or psoriasis. Prolonged use of steroids and fluoroquinolone-based antibiotics. Family history and old age. While nullifying the chances for Achilles tendinopathy as you age might not be possible, there are definite ways to reduce the risks: Gradual progression of activity level in terms of load, frequency, and intensity while training. Sufficiently stretch calf muscles and Achilles tendon before and after strenuous activities. During the winter, ensure enough protection of your feet from the cold. Wear shoes with sufficient cushioning for the heels and rigid arch support. Regular calf strengthening exercises can enable better stress handling by your Achilles tendon.
DiagnosisInitial diagnosis generally starts with physical verification of the affected areas. Doctors apply pressure to locate pain, inflammation, and tenderness. Additionally, your doctor will try to assess the flexibility and alignment of the injured area. This is vital to defining the permissible range of motion for your injured ankle and foot. Subjective assessments are crucial to relate injuries with the mechanism and conditional history. An unexpected course of symptoms might result in your doctor prescribing a few imaging tests. This might also be the case while considering surgery.
X-Rays: Tendons are soft tissues that are unrecognizable through x-rays. As such, x-rays are mainly performed on the calcaneus that forms your heel. This might be helpful in ruling out alternative conditions for the discomfort.
Ultrasound: Real-time images of Achilles in action can be obtained through ultrasound. The collagen integrity and water content of tendons, along with blood circulation, can be accurately visualized through color-Doppler ultrasound.
Ankle MRI: For even more clarity of tendon signals, MRI machines can combine radio waves with magnetic forces to analyze ankle tissues. Another potential enhancement to ankle MRI can be the more recent use of ultra-high frequency magnetic resonance or MRI UHF. These assist in studying the biomechanical and structural effects on injured Achilles tendons.
Self-CareSelf-care does a spectacular job of easing the initial signs of Achilles tendinopathy. You can start by allowing ample rest to your injured tendons. Also, avoid activities that may have supposedly triggered your injury. If these methods do work, you can restart with some gentle stretches for your calf and tendons. You can progressively try walking around with weights attached to your legs without overloading them too much. Walk on flat surfaces before attempting uphill or downhill movements. Early inflammations can be treated with cold packs applied over swollen areas at regular intervals. If discomfort persists even after 7-10 days, it might be a better idea to get a second opinion from your physio.
MedicationOver-the-counter medications should sufficiently relieve pain and inflammation due to your tendon injury. But continuing these for a longer duration is not recommended. You may consider ibuprofen, paracetamol, or naproxen for immediate discomfort. These medicines are steroid-free and hence prescribed for Achilles tendinopathy. However, your pharmacist should be aware if you are taking any other antibiotic while healing your tendinopathy.
PhysiotherapySelf-care and medication for pain are temporary solutions. But if your discomfort continues beyond a week’s time, you must consult a physio for your condition. Stretching and strengthening exercises are typical prescriptions for injury rehab. Your strengthening regime will include majority eccentric exercises for proper conditioning. See your physio for two to three sessions per week, and continue for at least six weeks. Your eccentric therapy may include heel lowering patterns to quicken recovery with pain reduction.
SurgerySurgery is the last resort for damage repair when it comes to Achilles tendinopathy. Doctors decide on surgery majorly for torn tendons or persistent patient discomfort. Surgeries are done to remove spoiled areas of your tendons and repair the rest. Such repairs might require tissue grafting from higher Achilles or alternate tendons. Generally, the healing time after surgery is substantial, and your serious efforts can only ensure complete recovery over time.
Recovery ForecastAlthough a majority of patients struggling with Achilles tendinopathy recover well, there are chances of recurrence in the future. Such probabilities have been reported to last for at least a decade from initial recovery, despite treatments. As such, a long-term prognosis might be difficult for individual cases. Depending on the severity of your injury, Achilles treatments can effectively reduce motion restrictions within three months of continuous therapy. However, left untreated, tendon injuries might require additional healing time due to worsening of conditions.
RecurrenceBefore returning to the field or professional training, spending enough time on recreational activities within your pain tolerance limits is advisable. Generally, a more eager return to professional sport can be linked to a higher recurrence of tendon injuries. Gradual build-ups, in terms of load-bearing and intensity, can provide better results after recovery. By doing so, you can give yourself a quicker chance of returning to play with a lowered risk of recurring injury. Continue with your strengthening regime for calves and tendons even after complete recovery to keep injuries at bay. As evident from our discussion, Achilles tendinopathy can be rectified with early diagnosis and appropriate therapies. Moreover, certain preventives from your side can delay inevitable tendon injuries until you age. Although self-care at home is fine to start with immediate pain control, persistent discomfort with your tendons needs assessment from the experts. For any further information related to tendon injuries, please visit us at https://www.movement101.com.au/.
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