Achilles Tendon Injuries

 

 

These injuries are quite common amongst runners and can be difficult to get rid of.

 

They are most commonly caused by overuse, though other contributory factors include incorrect footwear for your running style and excessive amounts of training on a particular surface, (very often, too much hill running or too much running on softer surfaces, especially sand).

 

Injuries range from Achilles Tendonitis through to partial or complete rupture of the tendon.

 

It is important to seek and follow medical advice as soon as possible. Leaving an injury like this is likely to make it worse, and make the recovery period much longer.

 

The information below is taken from http://www.sportsinjuryclinic.net/cybertherapist/back/achilles/tendinitis.htm

 

Achilles tendonitis accounts for around 11% of all running injuries. The Achilles tendon is the large tendon at the back of the ankle. It connects the large calf muscles to the heal bone and provides the power in the push off phase of the running cycle. The Achilles tendon can become inflamed through overuse as well as a number of contributory factors. The Achilles tendon has a poor blood supply, which is why it is slow to heal.

 

Achilles tendonitis can be acute or chronic. Acute Achilles tendonitis may happen as a result of overuse or training too much, too soon especially on hard surfaces or up hills.

 

Symptoms

 

·          Pain on the tendon during exercise. Achilles pain will gradually come on with prolonged exercise but will go away with rest.

·          Swelling over the Achilles tendon.

·          Redness over the skin.

·          You can sometimes feel a creaking when you press your fingers into the tendon and move the foot.

 

Chronic Achilles tendonitis may often result if the acute tendon injury is not treated properly or allowed to heal. Chronic Achilles tendonitis is a difficult condition to treat. The pains experienced during the acute phase of the injury tend to disappear after a warm up but return when training has stopped. Eventually the injury gets worse and worse until it is impossible to run.

Symptoms for chronic Achilles tendonitis are similar to those of acute tendonitis as well as:

 

·          Pain and stiffness in the Achilles tendon especially in the morning. This pain may be along the whole tendon rather than a specific point.

·          There may nodules or lumps in the Achilles tendon, particularly 2cm above the heel.

·          Pain in the tendon when walking, especially up hill or up stairs.

·          Chronic tendonitis differs from acute tendonitis in that it is more of a long term persistent problem.

 

Causes of Achilles tendonitis

 

·          Overuse. Too much too soon is the basic cause of overuse injuries, however other factors can make an overuse injury more likely.

·          Running up hills will mean the Achilles tendon has to stretch more than normal on every stride. This is fine for a while but will mean the tendon will fatigue sooner than normal.

·          Overpronation or feet that roll in can place an increased strain on the Achilles tendon. As the foot rolls in, (flattens), the lower leg rotates inwards also which twists the Achilles tendon place twisting stresses as well as stresses along its length.

·          Wearing high heels consistently and then expecting to run 5 miles in flat running shoes puts abnormal strain on the Achilles tendon making it stretch further than it is comfortable.

·          Wearing the wrong shoes or shoes that are too old. Go to a specialist running shop, where you will get good advice. I recommend Sweatshop at Wrea Green.

·          Not warming up properly.

·          Not stretching the calf muscles.

 

Treatment

·          Rest and apply cold therapy or ice (not directly onto the skin).

·          Wear a heel pad to raise the heel and take some of the strain off the Achilles tendon. This should be a temporary measure while the Achilles tendon is healing. Do not leave it there forever and only use if you are or intend stretching. If the calf muscles adaptively shorten, an increased strain will be placed on the Achilles tendon in future.

·          See a sports injury professional who can advise on treatment and rehabilitation.

·          Identify the cause of the injury. Training too much too soon, training on soft surfaces, wearing the wrong shoes or shoes that are too old and not warming up are possible reasons for the injury occurring. Also, if you over pronate, the Achilles is twisted putting more strain on it.

·          Rest - use crutches if needed. A good taping method is available which supports the tendon.

·          Anti-inflammatory medication can be taken (under Doctors advice of course).

·          Maintain fitness by non weight bearing exercise such as cycling if pain allows. There is still a strain on the tendon when cycling and swimming so if your injury is bad rest only.

·          Concentrate on improving the flexibility of the calf muscles, (Gastrocnemius and Soleus). This will reduce the strain on the Achilles tendon.

·          Two stretches in particular are important, one with a straight leg for the Gastrocnemius muscle and one with the leg bend to target the Soleus muscle. Stretching should be done regularly, three times a day initially and should be maintained long after the injury has healed to prevent the injury returning.

·          See a sports massage therapist. This will help remove and prevent adhesions, (sticky bits), forming. These adhesions stop the tendon sliding smoothly in its sheath.

·          Sports massage should also be used on the calf muscles themselves to aid in improving the flexibility and general condition of these muscles.

·          Continue to have regular sports massage on a 2 or 4 weekly basis to prevent the injury returning.

·          Strengthen the Achilles Tendon. It is important that you do this in the stretched position.

·          When you have gone at least a week without pain then you can begin to return to training. If you feel pain when returning to training then stop. Begin each training session with a walk to warm up followed by stretching.

·          After training apply ice or cold therapy to the tendon for 10 minutes to help prevent inflammation from returning.

·          Gradually increase the duration of your runs. No more than 10 % per week is usually recommended. If your sport demands sprinting then gradually increase the speed.

·          Continue with the stretching and strengthening programmes. It is important to do these even if you do not gain pain at this stage. Continue for at least three months. Continue to ice the tendon after training. You should now be ready to start back in full training but never neglect stretching and strengthening of the Achilles tendon or the injury might return.

 

Partial Achilles Tendon RUPTURE. A partial Achilles tendon rupture can occur in athletes from all sports but particularly running, jumping, throwing and racket sports. The tendon tears but not completely. Scar tissue will form, which is likely to lead to inflammation of the tendon. Often the athlete will not feel the Achilles tendon rupture at the time but will become aware of it later when the tendon has cooled down.

 

Symptoms include:

 

·         A sudden sharp pain in the Achilles tendon. (Sometimes the athlete will not feel a sharp pain at the time of the tear but pain will come on when cooled down.)

·         When returning to exercise after a short period of rest, there may be a sharp pain which disappears when warmed up only to return when stopped.

·         Stiffness in Achilles tendon first thing in the morning.

·         A small swelling in the tendon.

 

Treatment

 

As for Achilles tendonitis.

 

Total Achilles Tendon Rupture

 

Symptoms

 

·         A sudden sharp pain as if someone has whacked you in the back of the leg with something.

·         This will often be accompanied by a loud crack or bang.

·         You will be unable to walk properly and unable to stand on tip toe.

·         There may be a gap felt in the tendon.

·         There will be a lot of swelling.

 

Treatment

 

·         Seek professional help immediately. The sooner you get this injury operated on the more chance you have of making a full recovery. Any longer than two days and you are in trouble.

·         You can expect to be out of competition for 6 to 9 months after surgery. This is increased to 12 months if you just have the Achilles immobilized in plaster instead of operated on. There is also a greater risk of re-injury if you do not have the surgery.

 

Source: http://www.sportsinjuryclinic.net/cybertherapist/back/Achilles/Achillestotal.htm

 

Haglund's Syndrome & Haglund's Deformity. When Achilles bursitis exists at the same time as Achilles tendonitis in the same leg, this is known as Haglund's syndrome.

 

Bursitis is inflammation of the bursa (a small fluid filled sac) at the back of the heel bone and Achilles tendonitis is inflammation of the Achilles tendon.

 

A bony growth that appears at the back of the heel bone can occur. This growth is a benign cartilaginous growth and is known as Haglund's deformity.

 

Treatment

·         Rest and take anti-inflammatory medication for the bursitis.

·         Treat the Achilles tendonitis.

·         If Haglund's deformity is present and conservative (initial) treatment has failed then surgery may be necessary. To repair the Achilles tendonitis or tendonitis. And to remove the bony lump

 

Source: http://www.sportsinjuryclinic.net/cybertherapist/back/Achilles/haglunds_syndrome.htm

 

Disclaimer: Please note the above is intended as a guide only and should not take the place of a diagnosis from a medical professional.

 

Brian Porter MHFST - Submitted: 3rd August 2006