ORTHOPAEDICS INTERNATIONAL
The Achilles tendon is the largest and strongest tendon in the body, playing a crucial role in walking, running, and jumping by connecting the calf muscles to the heel bone. Despite its strength, it is susceptible to overuse injuries, particularly Achilles tendonitis. This condition is common among athletes and active individuals, making early recognition and appropriate treatment essential for recovery.
What is Achilles Tendonitis?
Achilles tendonitis refers to the inflammation of the Achilles tendon due to repetitive stress and strain. Unlike chronic tendinosis or tendon ruptures, it is an acute condition often caused by overuse. Factors such as excessive physical activity, improper footwear, sudden changes in exercise intensity, and biomechanical issues (e.g., flat feet or tight calf muscles) contribute to its development.
Common Causes of Achilles Tendonitis
- Overuse: Repetitive strain from activities like running and jumping.
- Improper Footwear: Shoes lacking proper support can increase tendon stress.
- Sudden Increase in Activity: Rapid changes in training intensity or duration.
- Poor Biomechanics: Issues like flat feet or tight calf muscles leading to abnormal stress on the tendon.
Recognising the Symptoms
- Pain or stiffness in the back of the heel, especially in the morning or after exercise.
- Swelling and tenderness along the tendon.
- Increased pain with physical activity.
- Limited ankle flexibility or difficulty pushing off the foot.
If symptoms persist despite rest or worsen over time, seeking medical evaluation is crucial to prevent complications such as tendon rupture.
Diagnosis and Risk Factors
Diagnosis
- Physical Examination: Assessment of tenderness, swelling, and flexibility.
- Imaging Tests:
- Ultrasound: Identifies tendon inflammation and structural issues.
- MRI Scan: Helps rule out severe degeneration or tendon tears.
Risk Factors
- Age: Older individuals have reduced tendon elasticity, increasing susceptibility.
- Improper Training Techniques: Inadequate warm-ups, excessive hill running, and abrupt activity changes.
- Medical Conditions: Flat feet, weak calf muscles, and metabolic conditions like diabetes.
Treatment Options for Achilles Tendonitis
Non-Surgical Treatments
- Rest and Activity Modification: Reducing high-impact activities to allow healing.
- Ice Therapy and Compression: Helps manage inflammation and pain.
- Medications: NSAIDs provide temporary relief.
- Bracing and Orthotics: Taping, bracing, and custom shoe inserts help support the tendon.
- Physiotherapy: Eccentric strengthening exercises to rebuild tendon strength and flexibility.
- Shockwave Therapy and PRP Injections: Stimulates healing in persistent cases.
Rehabilitation and Recovery
- Expected Recovery Timeline: Mild cases resolve within weeks; chronic cases may take months.
- Return to Sports: Gradual reintegration with proper conditioning.
- Cross-Training: Low-impact activities like swimming and cycling help maintain fitness during recovery.
Surgical Intervention for Severe Cases
Surgery is considered if non-surgical treatments fail after six months, especially for severe degeneration or irritation from a bone spur.
Types of Surgery
- Debridement and Repair: Removal of damaged tendon tissue with tendon reconstruction if necessary.
- Debridement and Tendon Transfer: Using the flexor hallucis longus (FHL) tendon to reinforce a severely damaged Achilles tendon.
- Gastrocnemius Recession: Lengthening tight calf muscles to relieve tendon strain.
- Haglund’s Deformity Removal: Removing a bony bump on the heel causing tendon irritation.
Post-Surgical Recovery Timeline
- First 2 Weeks: Immobilization with a cast or boot, limited weight-bearing.
- 4 to 6 Weeks: Gradual weight-bearing with physiotherapy.
- 3 to 6 Months: Progressive strengthening exercises.
- 6 to 12 Months: Full recovery and return to sports.
Potential Risks and Long-Term Considerations
- Complications: Infection, nerve damage, stiffness, or tendon re-rupture.
- Long-Term Management: Proper conditioning, stretching, and footwear can help prevent recurrence.
- Surgical Consideration: Reserved for complete ruptures or severe degenerative changes.
Preventing Achilles Tendonitis
- Proper Warm-ups and Stretching: Dynamic stretching and calf exercises before activities.
- Gradual Progression: Slowly increase workout intensity and duration.
- Appropriate Footwear: Well-cushioned shoes and orthotics for added support.
- Strengthening Exercises: Focus on calf and ankle stability to prevent strain.
Conclusion
Achilles tendonitis is a manageable condition when identified early and treated appropriately. Prevention through proper training, footwear, and strengthening exercises is key to avoiding recurrence. If symptoms persist or worsen, seeking professional medical advice is crucial for adequate recovery.
At Orthopaedics International, our specialists provide expert diagnosis and comprehensive treatment plans to help you recover and regain mobility. Schedule a consultation with Dr Wong Yu Shuen, our Orthopaedics Specialist today to take the first step toward healing.
