Achilles’ tendinitis, an overuse injury of the foot

Achilles’ tendinitis is an overuse injury most commonly reported in conditioned runners who push their performance levels. It is also reported in middle aged people who engage in aggressive weekend sports as the structure of the Achilles tendon tends to weaken with age. This painful condition happens when the large tendon located at the back of the lower leg becomes irritated and inflamed.

Early treatment for Achilles’ tendinitis

Onset of Achilles tendinitis is treatable in most cases at home following fairly simple directions provided by a physician. Future occurrences can be prevented in advance with a little awareness and proactive measures. Severe cases of Achilles tendinitis need to be treated immediately as it can lead to tendon tears requiring surgical repair.

Common symptoms of Achilles tendinitis

Achilles’ tendinitis usually arrives as a dull ache at the back of the leg or just over the heel. Symptoms emerge following activities that involve some range of running action. Pain is frequently reported as severe in cases where patients have recently engaged in prolonged running, sprinting or even climbing stairs. Tenderness or stiffness can also manifest following activity, particularly in the morning, which usually improves with mild activity. When symptoms of pain persist around the Achilles tendon, it is advisable to seek medical help – particularly important when the pain or disability is severe, as this type of extreme pain may indicate a torn or ruptured Achilles’ tendon.

Treating Achilles’ tendinitis at home

Simple nonsurgical treatment options will generally provide adequate pain relief, although it may take a few months for symptoms to completely abate. It is not uncommon for the pain to last longer than three months. Treatments can include anti-inflammatory pain medications, activity modification, a change in footwear and mild physical therapy exercises.

Cortisone injections to the Achilles tendon are not recommended because it can lead to rupture and decreased tendon strength – a situation that has played out in numerous studies. However, platelet-rich plasma (PRP) has also been extensively studied for Achilles’ tendinitis, and it has shown to generate significant improvements for healing and pain relief.

When surgery is recommended

In cases where pain does not improve after six months, surgery may be indicated. Depending on the actual location of the tendinitis and the extent of damage to the tendon, individual surgery options may vary. Results of Achilles tendinitis surgery are generally very good.

More extreme cases require orthopaedic expertise and longer recovery

Debridement is one type of surgery recommended for situations where the removal of bone spurs and damaged tendon tissue is necessary. During this procedure the damaged portion of the tendon is removed, while the remaining tendon is reattached to the heel bone. Metal or plastic anchors may also be positioned into the heel bone to support the tendon. After debridement and repair, most patients are allowed to use a removable boot or cast within two weeks, although it can take longer depending on the severity of the injury. Studies on tendon debridement have a reported return to pre-surgical activity level in as many as 75 percent of cases, with up to a 90 percent patient satisfaction rate.

The main factor in surgical recovery is the amount of damage to the tendon. The greater the amount of tendon involved, the longer the recovery period, and the less likely a patient will be able to return to sports activity. Sometimes the Achilles tendon has been damaged beyond repair and additional tendon tissue must then be transferred from the bottom of the patient’s big toe and reattached to the heel where it will support repair and recovery without inflicting damage to the big toe.

Recovery after surgery

The time it takes for full recovery depends largely on the amount of damage to the tendon. The general rule of thumb is the greater the amount of tendon involved, the longer the recovery period. When damage is extensive, patients are less likely to return to sports activity. And, as with many orthopaedic surgeries, physical therapy is an important part of the recovery process. Many patients require up to a full year of rehabilitation to reach maximum recovery.

 

Story source: AAOS Ortho Info

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SRO Foot & Ankle Center