Achilles tendonitis

The back of the leg commonly known as the calf is made up of three muscles: the Soleus muscle and two Calf muscles. These muscles join at the heel level into a single tendon to attach to the posterior part of the calcaneal bone. This tendon is called the Achilles tendon.

The Achilles tendon is the thickest and most powerful tendon in the body. It has a length of 6 cm, a width of 1.5 cm and a thickness of 5-6mm. The pathology of this tendon has undergone a notable increase in recent years due to the increase in sports practice in the general population and the average age of athletes.

The suffix “itis” means inflammation, so Achilles tendonitis will be its inflammation. This inflammation is located in the back of the heel. This term encompasses both inflammatory and degenerative phenomena, that is, the same pathology encompasses different causes, although the symptoms are the same.

Causes of this tendonitis

There are different causes that can cause Achilles tendonitis such as:

1. Infectious diseases of the musculoskeletal system.
2. Sports that require repeated jumps or those that repeat a movement over a long period of time: long distance or half distance runners, marathon, cycling, volleyball, dance, gymnastics, basketball, long jump, etc.
3. Deformities or deviations in the feet can cause inflammation of the Achilles tendon such as valgus or varus heels or alterations in the supports when walking.
4. Deformities or deviations in the legs and lower limbs.
5. Wearing unsuitable footwear for the sport you are doing or playing sports with overly worn footwear can cause Achilles tendon problems. It is important to take into account the wedges on the back of some sneakers as well as excessive wear on the soles, which can force the foot into abnormal positions and damage the tendon.
6. The type of terrain where the sport or training is carried out is also important when it comes to causing possible Achilles tendonitis. For example, the abuse of training on hard or synthetic terrain can initiate tendon pathology.
7. Lack of prior warm-up before starting sports practice.

Production mechanisms

The producing circumstances of Achilles tendonitis will cause damage at the level of the tendon that develops an injury to the body of the tendon. The producing mechanism is the repeated stress on the tendon as a result of an abuse of training or sports practice, a biomechanical decompensation of the foot, inadequate footwear or a poorly advised sports plan. Ultimately what happens is that the tendon is injured by the reproduction of injurious movements that are repeated too frequently.

The injuries will normally occur in the less vascularized area of ​​the tendon which is approximately 4 cm away. above its insertion into the calcaneus. In this area is where the ruptures and Achilles tendonitis will selectively settle.

The Achilles tendon is capable of supporting a traction of 400 kg of weight. If we imagine the number of strides that a marathon runner exerts during a 42,250 km test, we can imagine the traction to which he is subjected. Repeated microtrauma to the tendon will lead to the appearance of tendinitis and its associated symptoms.

In conclusion we can say that the loss of its physical or biomechanical properties will lead to the appearance of tendon pathology.

Symptoms of Achilles tendonitis

The symptoms that appear in Achilles tendonitis are:

• Pain that normally occurs in the morning and disappears with sports practice, to reappear after exercise to become continuous and chronic.
• Inability to perform physical activity and can even alter normal gait, preventing a normal life.
• Tendon tenderness.
• Appearance of painful nodules in the tendon body.
• Impossibility of making flexion-extension movements of the foot, since they produce sharp pain in the tendon area.
• Inflammation of the posterior area of ​​the heel located in the area of ​​the Achilles tendon.
• Redness of the posterior area of ​​the heel at the level of the Achilles heel.
• Pain on passive stretching and muscle contraction.

How is it diagnosed?

The way to diagnose Achilles tendonitis is a priori complicated using only a physical examination of the patient. Flexion-extension mobilizations of the foot and contractions against resistance cause pain, but this symptom alone is not helpful in diagnosing Achilles tendonitis.

These same symptoms can be found in other pathologies such as fibrillar tears or osteoarticular pathologies of the ankle joints.

To make an accurate diagnosis of the pathology, it is necessary to associate a series of complementary diagnostic tests, among which are:

• Blood tests to rule out rheumatic or metabolic diseases that can cause inflammation in the back of the foot.
• Simple radiology that allows observing the bone structure of the back of the foot to rule out problems at the osteoarticular level.
• Ultrasound: it is a non-invasive method that allows observing the structure of the Achilles tendon and visualizing injuries or inflammation of the tendon body.
• Nuclear magnetic resonance: it is the most specific and accurate diagnostic method that allows exploring the anatomy of the tendon and its possible alterations, giving a clearer and safer vision than with ultrasound or simple radiology.

Treatment for tendonitis

The treatment of Achilles tendonitis is achieved with several actions:

• Rest from physical or sports activity. It is essential to maintain a rest for 2-3 months
• Administration of non-steroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain.
• Infiltrations of corticosteroids always take care to space them ten days and not exceed three.
• Physiotherapy treatment with administration of laser, ultrasound or massage therapy. Massage therapy is very effective in this pathology.
• Treatment of alterations in the shape of the foot and in the way of walking and running of the person. It is necessary to analyze the general pathology of the foot and establish a treatment through the use of orthopedic insoles that correct the biomechanical defects that negatively influence the Achilles tendon.
• Advise the patient in the use of appropriate footwear that allows safe sports practice and prevents injuries to the Achilles tendon. It is necessary to use specific footwear for each sport and avoid the use of excessively worn sports shoes.
• Surgical treatment. It is the last treatment choice and you always have to reach it after exhausting at least three months of conservative treatment. It consists of eliminating the damaged areas of the tendon and giving it greater volume and solidity.

How to avoid it?

To avoid the appearance of Achilles tendonitis, I will have to take into account the following tips:

• Perform sports in a controlled and supervised way by a training plan appropriate to our age and dedication to the sports world.
• Wear sports shoes appropriate to the sport to be performed.
• Do not wear sports shoes when they have worn excessively and the sole is uneven, especially at the back of the shoe.
• Perform stretching prior to sports practice.
• Go to the Podiatrist at the time that it is suspected that there is an alteration in the way of walking or supporting the foot.

You should go to the Podiatrist when:

1. Notice that my walking or footing is not correct.
2. If I have been detected a pronator or supinator vice when running or walking.
3. If I need an orthopedic treatment through the use of insoles or shoe modifications.
4. If I have had pain in the back of my ankle during training or sports.
5. If I have noticed that my sports shoes wear out very quickly on the back of the sole.