Achilles tendinosis (also known as Achilles tendinopathy) is a soreness and stiffness that comes on gradually and continues to worsen until treated. It is a common injury
among middle and long distance runners. The severity of Achilles tendinosis can be broken down into four stages, each of which can be measured in terms of how the Achilles tendon feels during
exercise, the amount of stiffness and creaking, and Achilles tendon?s soreness to the touch (the Achilles tendon pinch test). The four stages, or grades, are, No pain during exercise, but there is
some discomfort in the morning when first getting out of bed. The stiffness and creaking go away after a few minutes and are fine the rest of the day. Lightly pinching the Achilles tendon with the
forefinger and thumb in the morning or after exercise will probably indicate soreness. Pain during exercise or running, but performance is not affected. The stiffness and creaking continue to appear
when first getting out of bed and continue to disappear shortly afterward. Lightly pinching the Achilles tendon with the forefinger and thumb in the morning or after exercise will indicate soreness.
Pain during exercise or running that is detrimental to performance. The stiffness and creaking continue to appear when first getting out of bed, but may continue for some time and reappear at other
points during the day. Lightly pinching the Achilles tendon with the forefinger and thumb in the morning or after exercise will indicate soreness. Hurts too much to exercise or run. The stiffness and
creaking continue to appear when first getting out of bed, but may continue for most of the day. Lightly pinching the Achilles tendon with the forefinger and thumb at almost any time of day will
There are a number of ways a person can develop Achilles tendinitis. Some causes are easier to avoid than others, but being aware of them can aid earlier diagnosis and help prevent serious injury.
Causes of Achilles tendinitis include, using incorrect or worn out shoes when running or exercising. Not warming up properly before exercise. Increasing intensity of exercise too quickly (e.g.
running speed or distance covered). Prematurely introducing hill running or stair climbing to exercise routine. Running on hard or uneven surfaces. Calf muscle is injured or has little flexibility
(this puts a lot of strain on the Achilles tendon). Sudden intense physical activity such as sprinting for the finish line. Achilles tendinitis can also be caused by differences in foot, leg or ankle
anatomy. For example, some people can have flatness in their foot where there would normally be an arch; this puts more strain on the tendon. The FDA has asked that a boxed warning be added to the
prescribing information for fluoroquinolone antibiotics. Patients taking these drugs may experience an increased risk of tendinitis and tendon rupture. Fluoroquinolones include Cipro (ciprofloxacin),
Factive (gemifloxacin), Levaquin (levofloxacin), Avelox (moxifloxacin), Noroxin (norfloxacin), Floxin (ofloxacin) and Proquin (ciprofloxacin hydrochloride). It is important to remember that the risk
for injury is not necessarily gone when the drug is stopped. Cases have been reported in which tendon problems occurred up to several months after the drug was discontinued.
A symptom is something the patient feels and reports, while a sign is something other people, such as a doctor, detect. For example, pain is a symptom, while a rash is a sign. The most typical
symptom of Achilles tendinitis is a gradual buildup of pain that deteriorates with time. With Achilles tendinitis, the Achilles tendon may feel sore a few centimeters above where it meets the heel
bone. Other possible signs and symptoms of Achilles tendinitis are, the Achilles tendon feels sore a few centimeters above where it meets the heel bone, lower leg feels stiff or lower leg feels slow
and weak. Slight pain in the back of the leg that appears after running or exercising, and worsens, pain in the Achilles tendon that occurs while running or a couple of hours afterwards. Greater pain
experienced when running fast (such as sprinting), for a long time (such as cross country), or even when climbing stairs. The Achilles tendon swells or forms a bump or the Achilles tendon creaks when
touched or moved. Please note that these symptoms, and others similar can occur in other conditions, so for an accurate diagnosis, the patient would need to visit their doctor.
X-rays are usually normal in patients with Achilles tendonitis, but are performed to evaluate for other possible conditions. Occasionally, an MRI is needed to evaluate a patient for tears within the
tendon. If there is a thought of surgical treatment an MRI may be helpful for preoperative evaluation and planning.
Make sure that the tendon is not torn through and through. If it is severed, you must see a doctor immediately so that the tendon can be repaired. Severe injuries can sever a tendon, without a skin
laceration being present. Testing involves moving the toes and foot to see if the tendon moves. If the tendon does not appear to move, it may be severed (comparing the injured tendon and its movement
to the same tendon on the uninjured foot may help). Very sharp pain, a sudden pop, or an obvious gap in the structure of the tendon are all signs of a rupture, and should be seen by a doctor as soon
as possible. If there is extreme swelling of the leg, and pain (out of proportion to the amount of trauma received), you may have sustained a vascular injury. A doctor must see this type of injury
immediately. If you are not sure, see a doctor. If you have multiple injured areas see a doctor immediately, in order to prevent excessive swelling and pain. If the above exam is negative, then you
may proceed with self-treatment. (However, if you are not sure of the extent of your injury, you should consult your doctor immediately). The sooner you begin to treat your injury by following
"R.I.C.E.", the better you will feel. Rest is very important. Take off your shoe, get off your feet, and relax. Ice should be applied as soon as possible. Never apply ice directly on the injured
area, as the cold may make the pain worse. Ice should be applied close to the injured site, between the heart and the injury, so that as the blood flows under the ice, it will be cooled. This cool
blood flowing into the injured area will help to reduce the swelling and pain. Apply the ice, wrapped in a cloth or over an elastic bandage, to the foot for 15 minutes, every 1-2 hours, for up to 3
days after an injury. If the ice is uncomfortable, or causes increased pain, do not continue to use it, and see a doctor. If you have poor circulation do not use ice, as this may cause a serious
problem. c. Compression is used to limit swelling, and to give support to the injured area. Compression should be applied to the entire foot, starting first at the toes and working back to the ankle.
If it is applied just to the injured area, increased swelling will occur in front and behind the wrapping. Compression should be applied with a 3-inch elastic bandage, beginning around the base of
all the toes, and then going around the foot and ankle. Continue over the calf muscle when possible. Compression reduces motion in the injured area and foot, and this decreases the pain, and allows
for quicker healing. The bandage should not be so tight that it causes increased pain or throbbing in the toes or foot. It should be comfortable! Do not remove the elastic bandage for the first 12
hours, unless it becomes too tight, or the pain increases, or the toes become pale, blue, or cool. If any of these things happen, immediately remove all bandages, and leave them off for several
hours. The normal color and temperature of the toes should return immediately. If not, see a doctor immediately! Continue until the swelling and pain subsides; it could take from several days to
several weeks. d. Elevation of the leg will aid in reducing swelling and pain. Blood rushes to an injured area to bring increased blood cells, that aid in healing. Gravity will also force blood to
the injured area. Too many cells and too much fluid will apply pressure to the injured nerves and tissues, and cause increased pain and delayed healing. Keep your foot elevated so that it is at least
parallel to the ground, or higher if it is comfortable. Do this for at least 48 hours, or until the throbbing subsides, when you lower the leg.
Surgery usually isn't needed to treat Achilles tendinopathy. But in rare cases, someone might consider surgery when rubbing between the tendon and the tissue covering the tendon (tendon sheath)
causes the sheath to become thick and fibrous. Surgery can be done to remove the fibrous tissue and repair any small tendon tears. This may also help prevent an Achilles tendon rupture.
So what are some of the things you can do to help prevent Achilles Tendinitis? Warm Up properly: A good warm up is essential in getting the body ready for any activity. A well structured warm up will
prepare your heart, lungs, muscles, joints and your mind for strenuous activity. Balancing Exercises, Any activity that challenges your ability to balance, and keep your balance, will help what's
called proprioception, your body's ability to know where its limbs are at any given time. Plyometric Training, Plyometric drills include jumping, skipping, bounding, and hopping type activities.
These explosive types of exercises help to condition and prepare the muscles, tendons and ligaments in the lower leg and ankle joint. Footwear, Be aware of the importance of good footwear. A good
pair of shoes will help to keep your ankles stable, provide adequate cushioning, and support your foot and lower leg during the running or walking motion. Cool Down properly, Just as important as
warming up, a proper cool down will not only help speed recovery, but gives your body time to make the transition from exercise to rest. Rest, as most cases of Achilles tendinitis are caused by
overuse, rest is probably the single biggest factor in preventing Achilles injury. Avoid over training, get plenty of rest; and prevent Achilles tendinitis.