Achilles Tendinitis
Achilles tendinitis is tendinitis of the Achilles tendon, generally precipitated by overuse of the affected limb and is more common among athletes training under less than ideal conditions. It should not be confused with xanthoma of the tendon, which is the accumulation of cholesterol in patients with familial hypercholesterolemia.
Pathophysiology
The Achilles tendon does not have good blood supply or cell activity, so this injury can be slow to heal. The tendon receives nutrients from the tendon sheath or paratendon. When an injury occurs to the tendon, cells from surrounding structures migrate into the tendon to assist in repair. Some of these cells come from blood vessels that enter the tendon to provide direct blood flow to increase healing. With the blood vessels come nerve fibers. Researchers believe these nerve fibers to be the cause of the pain.
Treatment
Treatment is possible with ice, cold compression therapy, wearing heel pads to reduce the strain on the tendon, and an exercise routine designed to strengthen the tendon. Some people have reported vast improvement after applying light to medium compression around ankles and lower calf by wearing elastic bandages throughout the day. Using these elastic bandages while sleeping can reduce morning stiffness but care must be taken to apply very light compression during sleep. Compression accelerates healing by improving circulation. Seeing a professional for treatment as soon as possible is important, because this injury can lead to an Achilles tendon rupture with continued overuse. Other treatments may include non-steroidal anti-inflammatory drugs, such as ibuprofen, ultrasound therapy, manual therapy techniques, arehabilitation program, and in rare cases, application of a plaster cast. Steroid injection is sometimes used, but must be done after very careful, expert consideration because it can increase the risk of tendon rupture. Severe cases may require surgery from an orthopedic surgeon or pediatric surgeon.
More specialised therapies include prolotherapy (sclerosant injection into the neovascularity) and lithotripsy.
High load eccentric contractions have recently been shown to be very effective at decreasing the pain and strengthening the tendon.
Prevention
Prevention includes following appropriate exercise habits and wearing low-heeled shoes. A physical therapist or athletic trainer can prescribe safe exercise methods.
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