The Achilles is the tendonous extension of two muscles in the lower leg: gastrocnemius and soleus . In humans, the tendon passes behind the ankle. It is the thickest and strongest tendon in the body. It is about 15 centimetres (6 in) long, and begins near the middle of the calf, but receives fleshy fibers on its anterior surface, almost to its lower end. Gradually becoming contracted below, it is inserted into the middle part of the posterior surface of the calcaneus, a bursa being interposed between the tendon and the upper part of this surface. The tendon spreads out somewhat at its lower end, so that its narrowest part is about 4 centimetres (1.6 in) above its insertion. It is covered by the fascia and the integument, and stands out prominently behind the bone; the gap is filled up with areolar and adipose tissue. Along its lateral side, but superficial to it, is the small saphenous vein. The Achilles’ muscle reflex tests the integrity of the S1 spinal root. The tendon can receive a load stress 3.9 times body weight during walking and 7.7 times body weight when running.
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Although it’s the largest tendon in the body and can withstand immense force, the Achilles is surprisingly vulnerable. And the most common Achilles tendon injuries are Achilles tendinosis and Achilles tendon rupture. Achilles tendinosis is the soreness or stiffness of the tendon, generally due to overuse. Achilles tendinitis (inflammation of the tendon) was thought to be the cause of most tendon pain, until the late 90s when scientists discovered no evidence of inflammation. Partial and full Achilles tendon ruptures are most likely to occur in sports requiring sudden eccentric stretching, such as sprinting. Maffulli et al. suggested that the clinical label of tendinopathy should be given to the combination of tendon pain, swelling and impaired performance. Achilles tendon rupture is a partial or complete break in the tendon; it requires immobilization or surgery. Xanthoma can develop in the Achilles tendon in patients with familial hypercholesterolemia.
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Achilles tendon, which feels like a very painful sudden kick in the back of the ankle and needs urgent repair. Inflammation of the tendon, or Achilles tendonitis, is more common.
•Mild pain after exercise or running that gradually gets worse
•Localised pain along the tendon during or a few hours after running, which may be quite severe
•Localised tenderness of the tendon about 3cm above the point where it joins the heel bone, especially first thing in the morning
•Stiffness of the lower leg, again particularly first thing in the morning
•Swelling or thickening around the tendon
There are several conditions that can cause similar symptoms, such as inflammation of a heel bursa (or fluid sac) or a partial tear of the tendon. You should see your doctor to confirm what’s causing your symptoms
Causes and risk factors:
To help prevent another attack, it’s important to know what triggers Achilles tendonitis in the first place.
Triggers may include:
•Overuse of the tendon – the result of a natural lack of flexibility in the calf muscles. Ask your coach about exercises specifically to improve calf muscle flexibility, and ensure your running shoes cushion the heel fully
•Starting up too quickly, especially after a long period of rest from sport – always warm up thoroughly
•Rapidly increasing running speeds or mileage – build your activity slowly, by no more than ten per cent a week
•Adding stair climbing or hill running to a training programme too quickly
•Sudden extra exertion, such as a final sprint
Diagnosis & Tests:
The doctor will perform a physical exam and look for tenderness along the tendon and for pain in the area of the tendon when you stand on your toes.
Imaging studies can also be helpful. X-rays can help diagnose arthritis, and an MRI will show inflammation in the tendon.
Treatment of Achilles tendonitis depends on the severity of the injury and whether you’re a professional sportsperson. Treatment includes:
•Rest, to allow the inflammation to settle. Any sport that aggravates the tendon should be sped for at least a week, although exercise that doesn’t stress the tendon, such as swimming, may be possible
•Regular pain relief with non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
•Bandaging and orthotic devices, such as shoe inserts and heel lifts, to take the stress off the tendon
•Physiotherapy to strengthen the weak muscle group in the front of the leg and the upward foot flexors
•Surgery (rarely needed) to remove fibrous tissue and repair tears
According to reports by Hakan Alfredson, M.D., and associates of clinical trials in Sweden, the pain in Achilles tendinopathy arises from the nerves associated with neovascularization and can be effectively treated with 1–4 small injections of a sclerosant. In a cross-over trial, 19 of 20 of his patients were successfully treated with this sclerotherapy.
Conservative therapy usually helps improve symptoms. However, symptoms may return if activities that cause the pain are not limited, or if the strength and flexibility of the tendon is not maintained.
Depending on the severity of the injury, recovery from an Achilles injury can take up to 12–16 months.
Prevention is very important in this disease. Maintaining strength and flexibility in the muscles of the calf will help reduce the risk of tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.
- Achilles tendinitis – All Information (umm.edu)
- Benayoun diagnosed with torn Achilles’ tendon (AP) (bogartkick.com)
- Tendinitis – All Information (umm.edu)
- Sixers’ Iguodala out with Achilles’ tendon injury (nba.com)
- The jury’s still out on injection therapy for tendinopathy (theglobeandmail.com)
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