ACHILLES TENDINITIS CAUSES, SYMPTOMS, PREVENTION & TREATMENT BY DR. ERIK NILSSEN

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Your is your body’s largest tendon that connects your heel bone to your calf muscles. You use it to run, walk, and jump. It is prone to Achilles tendinitis, which is a condition caused by degeneration and overuse, and is quite common. Achilles tendinitis causes you to suffer with pain down the back of your leg close to the heel.

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What is Achilles Tendinitis? To put it simply, it is inflammation of your tendon. There are a couple forms of Achilles tendinitis, which are determined primarily by the area of the tendon that is experiencing inflammation.

There are two common types.

Noninsertional Achilles Tendinitis. Patients who are between the ages of 30 and 40 with an increased level of activity tend to suffer with Noninsertional Achilles tendinitis. Patients with noninsertional Achilles tendinitis are often treated with non-surgical therapy and are able to gradually increase activity. Insertional Achilles Tendinitis. When the area that the heel bone and Achilles tendon connects becomes painful with swelling, this is known as Insertional Achilles tendinitis. There are both non-surgical and surgical treatment options for insertional Achilles

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Causes of Achilles Tendinitis Often individuals who are poorly conditioned have the higher risk of developing this condition. Other causes include:

• Sudden activity increase. • Tight calf muscles. • Bone spur(s). • Lack of conditioning or proper sports training. • Wrong footwear. • Knowing the causes can help you prevent Achilles tendinitis.

Bone Spur

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Who is at risk for Achilles Tendinitis?

There are various factors that could increase your risk of getting this condition. Some include:

1. Age. Achilles tendinitis becomes more common with age.

2. Sex/Gender. Achilles tendinitis is more common in men.

3. Athletes. Basketball players, marathon runners, and dancers are especially prone.

4. Having certain medical conditions such as:

• Psoriasis. This is a skin disease that leads to inflammation and scaling. Psoriasis involves cell turnover where your skin cells begin growing deep in your skin and gradually rise to the surface.

• Osteoarthritis. This condition is caused by injury, aging , and obesity. Common symptoms of osteoarthritis can include stiffness and pain. Certain joints, such as the wrist, hand, knee, neck, or hip can become affected and treatment usually involves exercise and medication.

• High blood pressure. As your heart pumps, blood is forced to push up against your artery walls. When this force gets too high, it is referred to as high blood pressure (hypertension). Bone Spur Gout. Gout is a type of arthritis that can cause sudden and serious attacks of pain, redness, tenderness, swelling, and warmth in your joints.

• . This condition affects the joints on both sides of your body, including the wrists, hands, and knees. Rheumatoid arthritis can also affect your eyes, blood, heart, lungs, nerves, and skin.

5. Taking certain medications. If you have a history of taking certain medications like quinolone antibiotics, you are at risk. These quinolone antibiotics include: (Ofloxacin and : Both treat bacterial infections and stop bacteria growth).

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Symptoms of Achilles Tendinitis

A common symptom of Achilles tendinitis is pain in the tendon that builds up gradually and deteriorates over time. It’s important to see your doctor or orthopedic surgeon for an accurate diagnosis since this symptom can mimic other conditions. Other symptoms include:

• You experience stiffness and pain along the Achilles tendon when you wake in the morning.

• Your pain along the back of your heel or tendon gets worse with activity.

• You experience serious pain after you exercise.

• Your tendon thickens.

• You get a bone spur.

• You experience swelling all day long that worsens with activity.

Because this is a degenerative condition that can change the structure of your tendon and lead to serious damage causing tearing and extreme pain, it’s important that you pay attention to your symptoms and seek medical evaluation.

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Prevention of Achilles Tendinitis

Although you can’t prevent Achilles tendinitis altogether, there are some things you can do to minimize your risk. Some ways include:

• Wearing the right footwear.

• Warming up and properly.

• Cooling down after exercise or other activities.

• Increasing your activity levels slowly.

• Staying away from activities that cause excessive stress.

• Alternating your workouts with lower impact exercises (swimming, cycling, rowing).

Start these low impact exercises gradually and work your way up to a faster pace. Slower is always better.

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Symptoms “When to Call a Doctor”

When the pain you feel around your Achilles tendon becomes persistent, it is time to give your doctor or orthopedic surgeon a call. If the pain becomes severe or causes you to become disabled, seek immediate medical care. This could be an indication that you have ruptured or torn your Achilles tendon.

Other reasons why you would want to call your doctor is if you are experiencing pain in the back of your and heel , it’s uncomfortable to walk, you see swelling in your Achilles tendon area, you notice damage to your blood vessels, have bluish pale skin in the affected area, or you are having tingling, numbness, and pins-and-needles sensations in your nerves.

Diagnosis of Achilles Tendinitis

Your doctor or orthopaedic surgeon gathers your patient history, performs imaging tests (MRI, X-rays, and Ultrasound), and conducts a to derive a diagnosis. Other things your doctor will check include flexibility, range of motion, alignment, and reflexes of your ankle and foot. All these evaluations combined will give your doctor an accurate assessment of your Achilles tendinitis diagnosis.

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Treatment of Achilles Tendinitis

There are various types of treatment available to you if you are suffering with Achilles tendinitis.

Non-surgical In many cases, you can get pain relief through nonsurgical treatments, but these could take several months before you notice any real changes in your symptoms. Even if you are treated early on, you could still wait up to three months or more to get relief.

Physical Therapy has been shown to be effective in treating some cases of Achilles tendinitis. It tends to work better for noninsertional tendinitis versus insertional.

Non-Steroidal Anti-Inflammatory Medication Your doctor might suggest that you take naproxen or ibuprofen to reduce swelling and pain. These medications, however, don’t help with reducing the thickening of a tendon that is degenerating.

Cortisone Injections This medication is a form of steroid and works as a strong anti- inflammatory medication. It is not recommended that often, however, since it can cause a tear or rupture to the tendon. heel lifts can minimize strain on the tendon.

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Orthotic Devices Certain shoes can help with insertional Achilles tendinitis, as well as orthotic devices. Shoes that have softer back heels can help minimize tendon irritation, for instance. Other devices like heel lifts can minimize strain on the tendon.

Stretches that Include Hamstrings and Calves These can help minimize the stress that is put on your Achilles tendon and strengthen your calf muscles. You simply lean against a wall holding one of your knees straight while your heel is on the floor. Your other leg is placed in front and your knee bent. You then push your hips towards the wall to stretch your calf muscles and hold this position for around 3 sets of 20 to 30 second holds. Relax your muscles in-between sets for both sides.

Bilateral Heel Drop Stand by a stable raised platform or edge of a stair, placing only the front part of your foot on the stair. Move your heel up and down, keeping your balance so you don’t fall or get injured. While holding onto a railing, lift your heels so they come up off the ground and then lower them slowly to as low as you can. This position can be repeated about 20 times.

Rest It’s important that you reduce activities that cause you pain or stop them altogether. If you normally like to run or perform other high-impact exercises, you can switch to lower-impact exercises like biking, swimming, rowing or elliptical exercises that will be less stressful to your Achilles tendon but still keep you active.

Ice You can place ice on the areas that hurt the most and repeat this as needed throughout your day. You shouldn’t keep ice on your Achilles tendon for more than 20 minutes, and if you notice your skin becoming numb, stop earlier.

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Surgery for Achilles Tendinitis Your other option is surgery. There are some different choices here as well.

When is Surgical Treatment Needed?

You should consider surgery for relieving pain of Achilles tendinitis if your pain doesn’t get any better after going through six months of nonsurgical treatments. The location of your tendinitis and how much damage there is to your tendon will determine the type of surgery you will need.

Some types of surgery include:

• Gastrocnemius recession. This surgery lengthens your calf muscles reducing the tension through the Achilles tendon and allowing a greater range of motion in the Ankle.

• Non-insertional Debridement. This surgery removes diseased or damaged tissue from the Achilles tendon leaving only healthy tissue.

• Insertional Debridement and Haglund’s resection. Over time micro tears occur in the Achilles tendon over the insertion site on the heel. Part of the tendon is detached from the heel to allow removal of the diseased or damaged tissue. Also a bony prominence on the back of your heel which can impinge on the Achilles tendon is removed. The tendon is then reattached to the insertion site using suture.

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Background on Dr. Erik Nilssen

Dr. Erik Nilssen is board certified through the American Academy of Orthopaedic Surgeons and American Board of Orthopaedic Surgery. He is the University Of South Alabama College Of Medicine’s Associate professor of Orthopaedic Surgery. He consults with numerous professional teams in the MLB, NBA, NFL and Olympic Sports. In addition to treating non-athletes with ankle and foot conditions, he specializes in sports medicine to provide professional athletes with the ability to recover from sports- related injuries and get back out there in the game performing at their very best. He is the guiding force and founder of Nilssen Orthopedic Ankle and Foot Center.

If you are experiencing pain in your Achilles tendon that worsens with activity or if the pain is so intense you can’t walk without weakness or extreme pain, book an appointment for evaluation and treatment at Nilssen Orthopedic Ankle and Foot Center.

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ANKLE / FOOT Stretching

Hamstring (Supine) Supporting right thigh behind knee, slowly straighten knee until stretch is felt in back of thigh. Hold 20-30 seconds.

Repeat 3 times per set. Do 1 sets per session. Do 2 sessions per day.

Calf – Towel Sit with knee straight and towel looped around right foot. Gently pull on towel until stretch is felt in calf. Hold 20-30 seconds.

Repeat 3 times per set. Do 1 sets per session. Do 2 sessions per day.

Gastroc Stand with right foot back, leg straight, forward leg bent. Keeping heel on floor, turned slightly out, lean into wall until stretch is felt in calf. Hold 20-30 seconds.

Repeat 3 times per set. Do 1 sets per session. Do 2 sessions per day.

Soleus Stand with right foot back, both knees bent. Keeping heel on floor, turned slightly out, lean into wall until stretch is felt in lower calf. Hold 20-30 seconds.

Repeat 3 times per set. Do 1 sets per session. Do 2 sessions per day.

/ 13 NILSSENORTHOPEDICS.COM | 855-998-FOOT The Nilssen Orthopedic center at the Andrews Institute is a multi-disciplinary medical treatment and research facility specializing in all ankle and foot disorders, sports injuries, prevention, rehabilitation, and athletic performance.

Our aim is to offer the same standard of care to all people who are or who is not involved in recreational exercises, dance, or sports no matter what level. This continuum of care approach means you have easy access to all aspects of our team, ensuring your injury be treated from the time of diagnosis through full rehabilitation.

The Nilssen Orthopedic Team is here to empower our patients to live pain free through technology, research, science, and patient-focused care. This Center sets itself apart by redefining quality and providing value-based care in a dynamic healthcare environment.

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