Achilles Tendinitis

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Achilles tendinitis is a very common overuse injury. It is common in runners and athletes but can affect non-athletic persons just as much. That is if the tendon is subjected to aggravated stresses and strains this can be due to an increase in intensity or duration of activity.

 

THE ACHILLES TENDON

 

The Achilles tendon is the largest tendon in the body. The Achilles tendon attaches the calf muscles gastrocnemius and the deeper muscle soleus to the calcaneum at the back of the ankle.

Anatomy of the Calf Muscles

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SOLEUS MUSCLES

 

The calf muscles on the back of the lower leg are made up of two muscles. The deeper muscle of the two is called Soleus which is a powerful plantar flexor of the ankle. Soleus muscle is a flat one joint muscle and attaches itself to the posterior side of the Tibia. Its attachment starts at the soleal line which is on the posterior upper third aspect of the Tibia. The Soleus muscle tapers lower down at the back of the leg into the Achilles tendon which in turn attaches the muscle to the heel bone known as the Calcaneum. Kinesiologists believe single joint muscles play a greater role in joint stabilisation and posture therefore Soleus works very efficiently in standing still position like a guardsman on parade.

     

GASTROCNEMIUS MUSCLE

 

The second muscle of the calf is the gastrocnemius. It is the more superficial muscle of the two calf muscles. This muscle is the bulk of the calf and produces the shape at the back of the lower leg. The gastrocnemius is classed as a two joint muscle because it crosses the knee joint above and ankle joint below. It attaches itself at the back of the Femur above the knee joint and like Soleus it also tapers down the lower part of the leg where it joins Soleus to form the Achilles tendon which attaches to the calcaneum at the back of the heel. The two heads of gastrocnemius originate and are attached to the medial and lateral epicondyles of the femur.

 

FUNCTION OF THE CALF MUSCLES

 

Soleus and gastrocnemius are the very strong plantar flexors of the foot. Gastrocnemius is also involved in flexing the leg at the knee joint. Gastrocnemius is the power – house of the two muscles and it is primarily involved in activities such as running jumping skipping and hopping along with any other fast motions of the leg. It is also active in walking and standing but to a much lesser degree. As mentioned before Soleus is the muscle involved in our stability and posture and works efficiently in standing.

 

 

MUSCLE FIBERS

 

White muscle fibres (fast twitch) are predominant in Gastrocnemius were as Soleus has predominantly red muscle fibres (slow twitch) and are more active in standing still.

Signs and Symptoms of Achilles Tendinitis

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In the athlete they will experience localised discomfort at first with increasing pain at the back of the heel. Like all injuries were an inflammatory process takes place the pain increases with sporting activities. Achilles tendinitis is a gradual worsening condition with a feeling of stiffness in and around the ankle itself. This stiffness is probably due to the inflammatory process going on in the tendon.

The tendon pain increases after exercise or activity and possibly the day after. Swelling redness (the tendon feels hot) due to the inflammatory reaction. Along with stiffness the person feels a loss of strength in the ankle, this is due to the pain as pain overrides muscle contraction. This is the bodies response to the painful Achilles tendon making the person rest to take the weight and stress off the tendon. If the inflammatory response continues to be aggravated and goes untreated then a swelling mid tendon appears and is a common appearance of a chronic tendinitis. A more general swelling mid tendon, red, hot and very tender is more of an acute inflammatory response.

In non-athletic people the discomfort starts to be noticeable even when walking.

Similar Achilles Conditions

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Achilles Tendinopathy

 

The first check is to make sure that the Achilles tendon is not ruptured.

An Achilles tendinopathy may take up to 12 weeks or more to fully to resolve.

Sometimes people with Diabetes are prone to the condition this can easily be ruled out by your GP or Doctor.

Advice is generally conservative treated with cold packs as you would treat sprains and strains.

Pain medication like anti-inflamatories may be taken, first seek the advice from your GP, Doctor or pharmacist.

 

Achilles Tendon Rupture

 

You can suffer a partial tear or rupture of the Achilles tendon.

If you over stretch your Achilles tendon it can rupture.

With a ruptured Achilles tendon you might hear a popping sound with immediate sharp pain at the back of your leg down by the heel.

This will more than likely affect your walking capabilities.

Surgery is the most common treatment for a ruptured Achilles tendon.

Non-Surgical treatment starts with lower leg immobilisation. A form of cast, walking boot or brace is normally applied to allow the Achilles tendon to heel. Once out of the cast or boot progressive exercises will be needed to build muscle strength, improve ankle mobility and balance.

Treatment

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For the first 24 to 48 hours you will need to follow these four steps to ensure a better faster recovery. This method is a tried and tested way to treat an Achilles tendinitis successfully.

 

One of the best tried and tested method is known as RICE:

 

Rest: Try to reduce pressure or weight through the Achilles tendon for the first few days. It might not resolve the Achilles problem, but it could help reduce the pain levels. It may also help the Achilles tendon to heal at a quicker rate. I have been known to administer crutches for a few days to help reduce the strain on the tendon if the pain is severe.

 

Ice: Apply an ice pack a quick and inexpensive form of ice pack is a bag of frozen peas wrapped in a thin cloth. This makes a great inexpensive ice pack because it moulds around the contours of the Achilles tendon. The recommended timings for ice applications is 20 to 25 minutes there are slight variations on timings for ice applications some would recommend slightly longer up to 30 minutes and some authorities may suggest a 15 to 20 minutes application. Allow 3 hours between ice applications if planning to repeat the process. Ice therapy helps cool the Achilles tendon and assists in reducing the swelling. Reducing the swelling helps relieve pain and ice packs are a good source of analgesia.

 

Compression: This can be done by wrapping a support bandage around the ankle to give it support. It will also make the ankle feel more comfortable & stable. Do not tie any strapping too tight as this may limit blood flow around the ankle. A compression sock or ankle support could be worn during the day if necessary. The wearing of some support may make the Achilles tendon feel less painful and more at ease.

 

Elevation: If you can then raise and support your foot higher than your heart. The reason for this is that it aids what is termed venous return this means it assists blood flow and helps in reducing the swelling. The easiest way of elevating the foot is to lay on the floor and place your foot on a soft covered chair and if you can keep it elevated for 20 minutes at a time. If you can do this then repeat this every few hours and certainly at the end of the day. If you have difficulty in raising your foot this high, then rest the leg slightly higher than your waist and keep it supported.

 

These stages depend on the severity of the Achilles tendinitis and the discomfort experienced by the individual. The compression and the elevation stages might not be necessary. Just resting in the early stages might be all that is required. One if not the most important thing in the early stage of your recovery is the ice treatment as this helps prevent swelling and acts like a mild analgesia thus reducing the pain. I would recommend you avoid any heat application like hot packs at first.

Rehabilitation Exercises

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 Passive stretches for the Achilles tendon

 

  1. Sit on the floor, rest your back against a wall for comfort, the affected leg out straight the other leg bent foot resting on the floor.
  2. Using a belt, exercise band or towel place it around and under the affected foot.
  3. Now gentle pull on the belt, exercise band or towel towards you bringing the foot towards the shin. Hold the stretch for 15 seconds then release the tension and repeat the exercise 10 times.
  4. Try to do this 3 to 4 times a day if possible.
  5. When this exercise is pain free move onto another exercise.

 

Stretching and Exercises for Achilles tendinitis

 

There are several other ways to stretch the Achilles once the pain is under control.

Achilles stretch in sitting is an alternative way instead of sitting on the floor.

 

Heel stretch – sit in a chair

 

  1. Sitting in a chair straighten the affected leg with the heel on the floor.
  2. With the use of a towel or belt placed around your foot gently pull your foot upwards towards the shin.
  3. Hold the stretch for 15 to 20 seconds and repeat 5 times through.

 

 

Heel stretch – leaning against a wall

 

  1. Stand a short distance away from the wall just short of an arm’s length.
  2. Place both hands against the wall at shoulder height.
  3. Step back with the Achilles you want to stretch.
  4. Keeping the leg straight place your heel on the floor.
  5. Keep your rear foot facing forwards.
  6. Gradually lean forwards and bend your front leg.
  7. When you feel the calf being stretched stop and hold this position for 20 to 30 seconds.
  8. Ease the tension off the calf for a few seconds and repeat the exercise 5 more times.

 

Heel stretch – standing on a step

 

  1. On a step stand with the balls of both feet on the edge of the step
  2. Use the banister or side wall for balance.
  3. Slowly lower your heel on the Achilles you want to stretch and hold for 20 to 30 seconds.
  4. Repeat the exercise 5 times.

 

HEEL STRENTHENING EXERCISES

 

Good quality studies have been done to evaluate the effectiveness of eccentric exercises. Current literature regarding Achilles tendinitis suggests that eccentric exercises are very effective in the treatment of pain and the restoration of function.

 

EXERCISE ONE

 

  1. Stand on the step on the balls of your feet and keep your heels over the edge of the step.
  2. Lift the un-effected leg off the step.
  3. Lower the heel of the affected leg, the Achilles tendon you want to stretch.
  4. Place your un-effected leg back onto the step and use it to lift the effected Achilles level back to the starting position.
  5. Repeat the exercise 10 times then do exercise two.

 

 

EXERCISE TWO

 

Perform the same exercise as above this time bend your knees slightly. Using the same sequence and the same quantity of exercises 10 repetitions.

Aim to complete 3 sets of 10 repetitions from each exercise from block one and two. That is a total or 60 repetitions.

 

Progress to exercise three only if your able to do exercises one and two pain free

 

Progression to exercise three. The sequence remains the same as in exercises one and two. Exercise three is different because you will have to take the weight of the affected leg on tip toes. That is with the toes on the step and the heel raised before transferring weight through the affected leg.

 

EXERCISE THREE

 

  1. Stand on the step on the balls of your feet and keep your heels over the edge of the step.
  2. With the un-effected leg raise up onto your toes taking all the body weight.
  3. Keeping the toes on the step and the heel raised of the affected leg transfer the weight of your body equally on both legs and slowly lower the heels of both legs.
  4. With the heels down transfer the whole weight of your body onto the un-affected leg and raise up your heel to the full height then bring the affected heel up beside it.
  5.  Transfer the weight of your body equally on both legs and slowly lower the heels of both legs.

 

Aim to complete 3 sets of 10 repetitions both with the leg straight and then with a slight knee bend.

That is a total of 60 repetitions

 

EXERCISE FOUR

 

Progression to exercise four. The sequence remains the same as in exercises one, two and three. Exercise four is different because you will now have to do the exercise lowering the whole weight of your body on the affected leg.

 

  1. Stand on the step on the balls of your feet and keep your heels over the edge of the step.
  2. With the un-affected leg raise up onto your toes taking all your body weight.
  3. Keeping the toes on the step and the heel raised of the affected leg, transfer all your body weight onto it and slowly lower your heel down.
  4. With the heel down on the affected leg transfer all your body weight onto the un-affected leg and raise up onto your toes with your heel at full height.
  5. Now bring your affected leg up beside it with toes on the step and heel raised.

 

Aim to complete 3 sets of 10 repetitions both with the leg straight and then with a slight knee bend. That is a total of 60 repetitions.

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