Injury or dysfunction of the Achilles tendon can range from tenderness to severe and debilitating pain. Achilles tendonitis is often used as an umbrella term to include involvement of various tissues on or near the tendon itself. While technically inaccurate, the vast majority of practitioners still adhere to this terminology because treatment is essentially the same for all these conditions.
Achilles Tendonitis
Achilles tendonitis is an inflammation of the tendon proper and does not include involvement of the tissues adjacent to it. While multiple tissue typically are involved, they represent separate conditions. Achilles tendonitis is characterized by pain and swelling, although it is not uncommon for either of these symptoms to be mild or even absent in the initial stages. Most tendonitis is a result of joint overuse, and Achilles tendonitis occurs in approximately 10 percent of runners. Nearly 75 percent of Achilles tendon injuries occur as a result of sports, according to a 2002 report published in the American Family Physician. The primary reasons commonly cited for stressing the Achilles tendon to its endurance limits are jumping and running.
Achilles Tendinosis
As tendonitis progresses without treatment, the next most severe phase of pathology is tendinosis. Achilles tendinosis is considered an overuse disorder primarily caused by sports activities. As the tendonitis progresses, the tendon tissue begins to degenerate. This results in the formation of small rips and tears in the tendon tissue, which is the hallmark of tendinosis. Often the degeneration occurs at the attachment of the tendon to the heel bone, producing pain when walking or running.
Achilles Paratenonitis
The Achilles tendon is covered by a paratenon, which acts like a sheath. Paratenonitis usually occurs in association with tendonitis. When the paratenon inflames, it adheres to the tendon adjacent to it and prevents the tendon from gliding smoothly. Tenderness and swelling result, and it is difficult to move the foot without pain.
Rupture and Avulsion
The next phase of severity following Achilles tendonitis and tendinosis, if left untreated, includes two very serious conditions. These are tendon rupture and avulsion. Rupture is a tear completely through the Achilles tendon itself. Avulsion is the condition in which the Achilles tendon actually pulls away from the heel bone. In either of these conditions, the pain is severe and walking is nearly impossible.
Treatments
The best treatment for problems with the Achilles tendon is prevention. Stretching the tendon before exercise and wearing the correct footwear are critical to healthy legs. Any foot abnormalities should be corrected with the appropriate orthotics before undertaking strenuous activities. Once tendonitis occurs, especially during its early phase, it is highly responsive to conservative treatments. Prolonged rest, ankle joint immobility, ice, heat and tendon massage are most often used. After several days, mild exercise can be slowly introduced. With treatment, tendonitis generally resolves within a few weeks. The more serious tendinosis and paratenonitis also require similar therapy but take longer to respond. They may also require advanced massage, ultrasound and physical therapy during their immobilization period. Both tendon rupture and avulsion require surgery for repair. Usually, casting is necessary and healing may take six to nine months.
References
- "American Family Physician"; Common Conditions of the Achilles Tendon; M. Mazzone and T. McCue; May 2002
- "Scandinavian Journal of Medicine and Science in Sports"; Etiology and pathophysiology of tendon ruptures in sports; P. Kannus and A. Natri; April 1997
- "Journal of Orthopedic and Sports Physical Therapy"; Chronic Achilles Peritendinitis: Etiology, Pathophysiology, and Treatment; N. Reynolds and T. Worrell; April, 1991
- Podiatry Today: How To Differentiate And Treat Tendon Pathology
- The Merck Manuals Online Medical Library: Sprains, Strains, and Tendon Tears
