Achilles Tendinitis

GENERAL INFORMATION:

What is it? Achilles (ah-KIL-eez) tendinitis (ten-dih-NEYE-tis) is pain and inflammation (in-flah-MAY-shun) (redness and swelling) of your Achilles tendon. A tendon is a cord of tough tissue that connects muscles to bones. The Achilles tendon connects the calf muscles to the heel bone. It is important to treat your Achilles tendinitis and allow it time to heal. If you do not, your Achilles tendon may rupture (tear) or become a long-term problem, possibly needing surgery.

What causes Achilles tendinitis? Following are some common causes of Achilles tendinitis:

• Overuse or overtraining. Achilles tendinitis can be caused by training or working out too much after not exercising for a while. It can be caused by adding too much time or distance to your athletic training. It may be caused by doing any activities that put stress (force or pressure) on the Achilles tendon. These include running uphill, jumping, or sprinting more than you usually do. These also include running or exercising on hard surfaces such as asphalt or cement.
  
  
• Poor fitting shoes. Poor fitting shoes can cause uneven movement of your foot and heel in the shoe. This includes shoes with worn out treads, and shoes that do not provide good heel support. Shoes that are too tight or small can rub and irritate the Achilles tendon. Shoes that are stiff and cannot bend where the toes join the foot can also put stress on your Achilles tendon.
  
  
• The way you walk or run. Your foot may roll inward too much when you walk or run. This is called overpronation (over-proh-NAY-shun). You may have high arches or may exercise in a way that puts stress on your Achilles tendon.
  
  
• Tight tendons and muscles. You may have tight hamstring and calf muscles in your upper and lower leg. Your Achilles tendon may be tight, thick, and unable to stretch very well. Your tendons become stiffer and easier to injure as you get older.
  
  
• Arthritis. Bony growths caused by arthritis, especially around the heel, can irritate the Achilles tendon.

• You may first feel pain when beginning to run or exercise. The pain usually goes away as your muscles warm up, but it may come back after exercising.
  
  
• Over time, if you do not rest your tendon and give it time to heal, the pain can get worse. You may have pain while exercising and even when you are resting. This may lead to small tears or a rupture (complete tear) of your Achilles tendon.
  
  
• If your tendon ruptures, you may feel sharp pain in the back of your heel. You may hear a "pop" and feel like the back of your heel was hit very hard. You may have pain and difficulty when trying to walk or move your ankle.

• Rest: The most important part of treating Achilles tendinitis is to rest. Rest may help decrease swelling and keep your tendinitis from getting worse. Your caregiver may tell you to stop your usual training or exercise activities altogether. Your caregiver may tell you to do other forms of exercise while your Achilles tendon heals. You may be able to swim or do other exercises that do not put stress on your Achilles tendon.
  
  
• Ice: Ice causes blood vessels to constrict (get small) which helps decrease inflammation. Put crushed ice in a plastic bag or use a bag of frozen corn or peas. Cover it with a towel. Put this on your Achilles tendon for 15 to 20 minutes, three to four times each day. Do this for two to three days or until the pain goes away. Do not sleep on the ice pack because you can get frostbite.
  
  
• Nonsteroidal anti-inflammatory medicine: This family of medicine is also called NSAIDs. Nonsteroidal anti-inflammatory medicine may help decrease pain and inflammation (swelling). Some NSAIDs may also be used to decrease a high body temperature (fever). This medicine can be bought with or without a doctor's order. This medicine can cause stomach bleeding or kidney problems in certain people. Always read the medicine label and follow the directions on it before using this medicine.
  
  
• Physical therapy: Physical (FIZ-i-kal) therapists (THER-ah-pists) can help you with special exercises and treatments to help your tendinitis heal faster. Treatments may include massage, ultrasound, or monochromatic (mon-oh-kro-MAT-ik) infrared (in-frah-RED) photoelectric energy (heat therapy). These treatments may help increase blood flow and decrease pain in your Achilles tendon. Exercises to stretch your Achilles tendon and make it stronger will be started after the tendinitis has healed.
  
  
• Shoe inserts: You may need to wear specially-made orthotics (or-THOT-iks) or over-the-counter inserts in your shoes. These may be rubber, silicone or felt pads for your heel, arch or the entire sole (bottom) of your foot. These may give the control, support or padding that is needed to decrease stress on your Achilles tendon.
  
  
• Stretching and strengthening exercises: Your caregiver may tell you to do stretches and special exercises at home. Stretching and making certain muscles stronger may help decrease stress on your Achilles tendon.
  
  
• Steroid injections: You may be given shots of medicine called steroids (STER-oids) to decrease inflammation. Caregivers may add local anesthesia (an-es-THEE-zah) to the steroids. This medicine helps decrease Achilles tendinitis pain. After getting this shot, you may feel like your Achille tendon is healed and that you can return to heavy exercise. Do not return to your regular exercise until your caregiver says it is OK. You could make the tendinitis worse, or even rupture (tear) the tendon, if you exercise too soon.
  
  
• Surgery: If your tendinitis does not heal with other treatments, you may need surgery. Surgery may be done if your tendon ruptures (tears). It may be done to remove tissue or parts of your Achilles tendon.
  
  
• Taping or casting: You may need to wrap special tape around your heel and back of the leg. You may need to wear a cast, brace or special "boot". These may help to support and decrease stress on your Achilles tendon while it heals.

• Wear shoes that fit correctly and support your feet. Replace your running or exercise shoes before the padding or shock absorption is worn out. Shock absorption greatly decreases as the treads on the bottoms or sides of your shoes begin to wear down. You may need running shoes that give your foot special heel or arch support. You may need shoe inserts to keep your foot from rolling inward too much (overpronation). Ask your caregiver which exercise shoes, heel inserts or specially-made orthotics are right for you.
  
  
• Start exercising when caregivers say that it is OK. Slowly start your exercise or training program as directed by your caregiver. If you are a runner, you may need to start by running shorter times and distances. Then you can increase your training in time. Continue to do exercises to keep your tendon stretched and leg muscles strong. Doing this will help decrease stress on your Achilles tendon.
  
  
• Stretch before exercising. Always warm up your muscles and stretch gently before exercising. Do cool down exercises when you are finished. This will loosen your muscles and decrease stress on your Achilles tendon.
  
  
• Exercise the right way. If you are a runner, increase your time and distance slowly over time. If your tendinitis is caused by the way that you exercise, ask a trainer, coach, or caregiver for help. They can teach you ways to train or exercise to help prevent Achilles tendinitis. For example, you may be told to avoid running on uneven or slanting surfaces. Do not run or exercise on surfaces that are very hard, such as asphalt or concrete. Instead, run on softer surfaces such as treadmills, rubber tracks, grass or evenly packed dirt tracks.
  
  
• Use ice after your workouts. Put ice on your Achilles tendon after exercising or if you begin to feel pain. Rest your Achilles tendon. Ask your caregiver if you should take anti-inflammatory medicine (NSAIDs).

• Your pain and swelling increase.
  
  
• You develop new, unexplained symptoms.
  
  
• You have a temperature over ____.