ACHILLES TENDINITIS

*ACHILLES TENDINITIS :-

Achilles tendinitis, also known as achilles tendinopathy, is when the Achilles tendon, found at the back of the ankle, becomes irritated.

*ANATOMY OF ACHILLES TENDON:-

ANATOMY OF ACHILLIES TENDON

The Achilles tendon (tendo calcaneus or tendo Achillis) is the thickest and strongest tendon in the human body. It is the tendinous extension of the three-headed calf muscle (consisting of soleus and the two-headed gastrocnemius). It inserts on the calcaneus. It is formed when the soleus muscle tendon joins with the gastrocnemius tendon.The tendon starts in the middle of the calf and extends approximately 15 centimeters in length, down to the heel, and passes vertically down, behind the ankle.

*PATHOPHYSIOLOGY :-

The Achilles tendon is the extension of the calf muscle and attaches to the heel bone. It causes the foot to extend (plantar flexion) when those muscles contract.
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. These nerve fibers to be the cause of the pain – they injected local anaesthetic around the vessels and this decreased significantly the pain from the Achilles tendon.

*SIGN & SYMPTOMS:-

SIGN & SYMPTOMS

Pain and stiffness along the Achilles tendon in the morning
Pain along the tendon or back of the heel that worsens with activity
Severe pain the day after exercising
Thickening of the tendon
Bone spur (insertional tendinitis)
Swelling that is present all the time and gets worse throughout the day with activity
Redness and warmth
Inflammation and crepitus also often occur with Achilles tendinitis

*CAUSES :-

> Achilles tendinitis is caused by repetitive or intense strain on the Achilles tendon, the band of tissue that connects your calf muscles to your heel bone. This tendon is used when you walk, run, jump or push up on your toes.

> The structure of the Achilles tendon weakens with age, which can make it more susceptible to injury — particularly in people who may participate in sports only on the weekends or who have suddenly increased the intensity of their running programs.

*DIFFERENTIAL DIAGNOSIS :-

> Achilles tendinosus, bursitis, paratendinitis, and rupture.
> Other conditions that should be kept in mind are global tightness of or myofascial trigger points within the gastrocnemius and/or soleus; these conditions can also result in pain with plantarflexion against resistance and pain and decreased dorsiflexion of the foot. And whenever there is pain in the posterior (lower) leg, deep vein thrombosis should be ruled out.

*DIAGNOSIS :-
> doctor will gently press on the affected area to determine the location of pain, tenderness or swelling. He or she will also evaluate the flexibility, alignment, range of motion and reflexes of your foot and ankle.
Imaging tests

> X-rays. While X-rays can’t visualize soft tissues such as tendons, they may help rule out other conditions that can cause similar symptoms.

> Ultrasound. This device uses sound waves to visualize soft tissues like tendons. Ultrasound can also produce real-time images of the Achilles tendon in motion, and color-Doppler ultrasound can evaluate blood flow around the tendon.

> Magnetic resonance imaging (MRI). Using radio waves and a very strong magnet, MRI machines can produce very detailed images of the Achilles tendon.

*MEDICAL TREATMENT :-
> Pain relievers:
Over-the-counter medicines like acetaminophen (Tylenol), ibuprofen (Motrin), and naproxen (Aleve) can lessen the pain of most Achilles tendon problems. For more severe pain, prescription pain relievers may be necessary.

> Compression bandages and orthotic devices:
Ankle supports and shoe inserts can aid recovery as they take the stress off the tendon. Heel lifts, which move the foot away from the back of the shoe, may help patients with insertional Achilles tendinitis.

*PHYSIOTHERAPY TREATMENT :-

> RICE therapy:
Most Achilles tendon injuries can be treated with RICE: Rest, Ice, Compression with a sports bandage, and Elevation.

> Heat:
Alternating ice and heat therapy may improve the pain of bursitis near the Achilles tendon.

> Footwear:
Wearing shoes with good support that are right for your feet may help avoid continual injury to the Achilles tendon. Custom-made orthotics, heel lifts, and certain splints and braces are sometimes helpful.

*EXERCISE THERAPY :-
1.Bilateral heel drop:

Bilateral heel drop

Stand at the edge of a step and hold on to a handrail. Only the front half of your feet should be touching the stair. Using your arms to support you, raise up onto the balls of your feet. Pause, then without leaning on your arms, slowly lower your heels down below step height. Do this 12-20 times.

2.Single leg heel drop:

Single leg heel drop

After you’ve mastered the bilateral heel drop on two legs, try rising up onto the balls of both feet, then lift one foot off the step and lower yourself using just one leg.

3.Calf stretch:

Calf stretch

Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your his toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch.

*DO’s &DON’Ts :-

DO wear cushioned shoes with a good base of support.achilles tendinitis
DO use an icepack 30 minutes before bed.
DO follow your doctor’s instructions.
DON’T wear flip flops, sandals, or shoes with little support.
DON’T walk on uneven surfaces.

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