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Achilles tendinosis occurs when the achilles tendon degenerates and becomes inflamed. The tendon can swell and may cause pain. This condition is common in athletes, runners and patients who have calf tightness. Achilles tendinosis may occur in the middle of the tendon. This is known as midsubstance achilles tendinosis. It may also occur at the point where the tendon connects to the heel bone. This is known as insertional achilles tendinosis.
What are the symptoms of achilles tendinosis?
Many changes can be seen when the achilles tendon becomes inflamed. Patients have pain and/or tightness in the tendon behind the ankle. Most of the time there is no trauma or injury, but rather a slow progression of pain. Patients may have difficulty climbing stairs or running. Patients may also have pain after sitting for long periods or after sleeping. Many patients will notice a bump either in the tendon (midsubstance achilles tendinosis) or right behind the heel bone (insertional Achilles tendinosis). Some may also get irritation from shoes rubbing against the bump and feel better when wearing backless shoes. Patients also commonly have less pain while wearing a shoe with a slight heel versus shoes that are flat.
What causes achilles tendinosis?
Achilles and calf tightness is a common cause of achilles tendinosis. In addition, insertional achilles tendinosis is often associated with a heel bone spur. This spur may rub against the achilles tendon and lead to breakdown and small tears. It is similar to a rope being rubbed against a sharp rock. This is also known as 'Haglund’s Syndrome'. Pain and swelling occur as the cumulative effects of chronic wear and tear on the tendon.
How is achilles tendinosis diagnosed?
A thorough history is taken and an examination is performed. Patients will usually have pain right on the tendon or at the back of the heel. They may also have swelling and thickening of the tendon. X-rays may be taken to see if there are any bone spurs. An MRI or ultrasound may also be performed to further evaluate how much of the tendon is affected and to look for any tears.
What are treatment options?
Treatment depends on the length and severity of the symptoms, with many patients improving without surgery. However, in some cases, a referral for surgery may be required. The specifics of the surgery depend upon the location and extent of the tendinosis.
A multi-faceted formal approach is in order that includes:
Frequently Asked Questions:
Patients improve with both conservative and operative management of achilles tendinosis. Physical therapy has been shown to help most patients with this condition and should be tried before surgical management is proposed.
Achilles tendon injuries can be successfully rehabilitated conservatively with hands-on treatment. Steroid injections and casting are seldom used these days. Once the local inflammation has been controlled, improved blood flow to the region of relative avascularity is necessary. Chiropractic joint mobilization techniques, correct stretching and strengthening exercises can be demonstrated and monitored in Dr. Pisarek's office. One of the most important long-term goals is to reduce any tendency to pronate excessively. In addition to custom-made orthotics (Footmaxx) , all runners should be encouraged to wear well-designed shoes that provide good heel stability with a small amount of additional heel lift. This helps prevent achilles tendon problems, and is especially important in athletes who run more than a few miles at a time.
Prevention of Achilles Injuries:
Prevention of achilles tendonitis can be achieved with slowly increasing activity, purchasing quality foot wear, stretching, and cross-training. People who have had a history of achilles problems need to be conservative with their exercise and training programs. Big problems and injuries to the achilles tendon occur most commonly after ignoring small problems and pains. Pain is a warning sign something is wrong. Ignoring the problem often creates a more extensive injury.
Prevent small achilles injuries from becoming large injuries that require more time and treatment to correct by calling Dr. Pisarek today at (416) 633-3000.
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I have been a patient of Dr. Pisarek for a few years now. Every morning I have to say "thank you Dr. P.!". Your care and your treatment renew my energy... no more pains in my lower back, knee and foot. With your help I lost 20 pounds and I am keeping it off. I am really grateful to you and your wife Hilda for taking care of me. My retirement got a new meaning, thanks to you.