The Achilles tendon is the thickened cord or fibrous band that runs down the back of one’s leg and attaches to the heel bone. A prime function of this muscle or tendinous structure is to assist in moving the foot up and down. Athletes at all competitive levels, frequently encounter problems with this tendon. It is subject to injury from a direct impact, can suffer from over use or excessive training, or can just start hurting as a result of shoe pressure. The patient with an Achilles tendonitis will most often have pain and swelling in the lower portion of the tendon just above the heel, will have discomfort when moving the foot upwards thus stretching the tendon, and will probably note that the condition has worsened over time. These patients can have significant discomfort and will frequently take themselves out of physical activities prior to visiting the physician.
Although we are unsure why certain individuals are more prone to develop this problem than others, there are certain factors, which seem to appear in the “cause” column. Trauma or injury to the Achilles tendon itself is an obvious cause of subsequent tendonitis. An abnormality in the way that one walks or what the medical authorities refer to as improper biomechanics can also create excessive strain upon the Achilles tendon resulting in localized swelling and pain. Over use, excessive training and improper stretching can also result in Achilles tendon injuries. The bottom line though, in most cases of Achilles tendonitis, is the same…pain, reduced range of motion, localized swelling, and a potential long-term problem that is usually slowly responsive to therapy.
In discussing the treatment approaches to an Achilles tendonitis, we must first mention the necessity of a thorough examination by a specialist. Fractures of the heel bone, partial ruptures of the tendon itself, and localized soft tissue problems must all be carefully considered and ruled out. The specific treatment of an Achilles tendonitis might include physical therapy, shoe padding (lifts to raise the heel), possible orthotics, oral anti-inflammatory medication, some form of immobilization, and reduced physical activity until the condition improves. Surgery, although mentioned for completeness is rarely used. It should be mentioned that this painful and often disabling condition, while frequently slow to respond, will usually improve and resolve with therapy over time.