Achilles tendinitis is often a misnomer, as most problems associated with the Achilles tendon are not strictly an inflammatory response. A more appropriate term, which most
experts now use, is Achilles tendinopathy which includes, Tendinosis, microtears in the tissues in and around the tendon. Tendinitis, inflammation of the tendon Most cases of Achilles tendon pain is
the result of tendinosis. Tendon inflammation (tendinitis) is rarely the cause of tendon pain. Achilles tendinopathy is a common condition that occurs particularly in athletes and can be difficult to
treat due to the limited vascular supply of the tendon and the stress within the Achilles tendon with every step. Evidence indicates that treatment incorporating custom foot orthoses can improve this
condition by making the foot a more effective lever in gait. A 2008 study reported between 50 and 100% relief (average 92%) from Achilles tendinopathy symptoms with the use of custom foot
Achilles tendonitis is aggravated by activities that repeatedly stress the tendon, causing inflammation. In some cases even prolonged periods of standing can cause symptoms. In many people who have
developed achilles tendonitis, chronic shortening of the gastroc-soleus muscle complex is the reason that home remedies and anti-inflammatory medications fail. In these instances the muscle itself
becomes shortened and creates a constant stress at the tendon?s attachment. Like a green branch that is slowly bent, eventually it begins to breakdown. Over a prolonged period the tendon becomes
inflamed, and in the worst cases, appears swollen and thickened. In certain circumstances attempts to heal have failed and the body?s inability to heal the tissue results in degenerative changes
known as achilles tendonosis. Anti-inflammatory medication, stretching and ice may only provide temporary relief, because they address the inflammation but not the root cause.
Pain anywhere along the tendon, but most often on or close to the heel. Swelling of the skin over the tendon, associated with warmth, redness and tenderness. Pain on rising up on the toes and pain
with pushing off on the toes. If you are unable to stand on your toes you may have ruptured the tendon. This requires urgent medical attention. A painful heel for the first few minutes of walking
after waking up in the morning. Stiffness of the ankle, which often improves with mild activity.
A doctor or professional therapist will confirm a diagnosis, identify and correct possible causes, apply treatment and prescribe eccentric rehabilitation exercises. An MRI or Ultrasound scan can
determine the extent of the injury and indicate a precise diagnosis. Gait analysis along with a physical assessment will identify any possible biomechanical factors such as over pronation which may
have contributed to the achilles tendonitis and training methods will be considered. Biomechanical problems can be corrected with the use of orthotic inserts and selection of correct footwear.
With proper care for the area, the pain in the tendon should lessen over three weeks, but it should be noted that the healing of the area continues and doesn't even peak until at least six weeks
following the initial injury. This is due to scar tissue formation, which initially acts like the glue to bond the tissue back together. Scar tissue will continue to form past six weeks in some cases
and as long as a year in severe cases. After 6 months this condition is considered chronic and much more difficult to treat. The initial approach to treating Achilles tendonitis is to support and
protect the tendons by bracing any areas of the tendon that are being pulled on during use. It is important to loosen up the tendon, lessen the pain, and minimize any inflammation.
Chronic Achilles tendon tears can be more complicated to repair. A tendon that has torn and retracted (pulled back) into the leg will scar in the shortened position over time. Restoring normal tendon
length is usually not an issue when surgery is performed within a few weeks of the injury. However, when there has been a delay of months or longer, the treatment can be more complicated. Several
procedures can be used to add length to a chronic Achilles tear. A turndown procedure uses tissue folded down from the top of the calf to add length to the Achilles tendon. Tendon transfers from
other tendons of the ankle can also be performed to help restore function of the Achilles. The results of surgery in a chronic situation are seldom as good as an acute repair. However, in some
patients, these procedures can help restore function of a chronically damaged Achilles.
Stretching of the gastrocnemius (keep knee straight) and soleus (keep knee bent) muscles. Hold each stretch for 30 seconds, relax slowly. Repeat stretches 2 - 3 times per day. Remember to stretch
well before running strengthening of foot and calf muscles (eg, heel raises) correct shoes, specifically motion-control shoes and orthotics to correct overpronation. Gradual progression of training
programme. Avoid excessive hill training. Incorporate rest into training programme.