What Is Achilles Tendinopathy
Achilles tendinopathy is caused by damage or inflammation in the tendon that runs from the calf in the lower leg, down the back of the ankle to the bone in the heel.
The main symptoms are:
- pain in the Achilles tendon which worsens after activity
- difficulty moving the foot up and down
- a grating sensation in the area
- swelling, redness or heat around the tendon
- a lump on the tendon.
It’s commonly caused by a tear or over-use of the Achilles tendon. It can affect anyone doing sports involving lots of running or jumping. People with very high or low arches in their feet can be prone to this problem, because this puts strain on the tendon.
Cracking Or Popping Sounds
When you bend or straighten your knee, you may feel a grinding sensation or hear cracking or popping sounds. Doctors call this crepitus.
These symptoms can occur when youve lost some of the cartilage that helps with smooth range of motion. Both OA and RA can result in cartilage damage.
When cartilage is damaged, rough surfaces and bone spurs develop. As you move your joints, these rub against each other.
Prevention Of Achilles Tendinopathy
Suggestions to reduce your risk of Achilles tendinopathy include:
- incorporate stretching into your warm-up and cool-down routines
- maintain an adequate level of fitness for your sport
- avoid dramatic increases in sports training
- if you experience pain in your Achilles tendon, rest the area. Trying to work through the pain will only make your injury worse
- wear good quality supportive shoes appropriate to your sport. If there is foot deformity or flattening, obtain orthoses
- avoid wearing high heels on a regular basis. Maintaining your foot in a tiptoe position shortens your calf muscles and reduces the flexibility of your Achilles tendon. An inflexible Achilles tendon is more susceptible to injury
- maintain a normal healthy weight.
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Does Achilles Tendinitis Need Surgery
If youve tried nonsurgical methods for six months and youre still in pain, talk to your provider. You may need surgery. A foot and ankle surgeon can suggest options based on your injury, age, preferences and activity level.
Surgical options include:
- Gastrocnemius recession: The surgeon lengthens the calf muscles.
- Debridement and repair: If most of the tendon is healthy, the surgeon removes just the damaged part and stitches together the remaining healthy tendon. After the procedure, youll wear a boot or cast for a few weeks.
- Debridement with tendon transfer: If more than half of the Achilles tendon is damaged, then theres not enough healthy part of the Achilles tendon to function. You need an Achilles tendon transfer. Your surgeon takes the tendon that helps the big toe point down and moves it to the heel bone. Treatment gives the damaged tendon enough strength to function. Youll still be able to move your big toe, walk and even run. But you may not be able to play sports competitively after this procedure.
- Hydrocision TenJet®: This minimally invasive, ultrasound guided technique uses high velocity saline to break up scar tissue in the tendon. The pressurized saline acts as blade to selectively remove unhealthy tissue. This is done on an outpatient basis.
How To Treat Tendonitis Yourself
Follow these steps for 2 to 3 days to help manage pain and to support the tendon.
- Rest: try to avoid moving the tendon for 2 to 3 days.
- Ice: put an ice pack on the tendon for up to 20 minutes every 2 to 3 hours.
- Support: wrap an elastic bandage around the area, use a tube bandage, or use a soft brace. You can buy these from pharmacies. It should be snug, not tight.
It’s important to take a bandage or brace off before going to bed.
When you can move the injured area without pain stopping you, try to keep moving it so the joint does not become stiff.
To help prevent further injury or pain, try to avoid:
- heavy lifting, strong gripping or twisting actions that make the symptoms worse
- playing sports, until the tendon has recovered
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How Will It Affect Me
If you have osteoarthritis of the knee, you will probably feel your knee is painful and stiff at times. It may only affect one knee, especially if youve injured it in the past, or you could have it in both. The pain may feel worse at the end of the day, or when you move your knee, and it may improve when you rest. You might have some stiffness in the morning, but this wont usually last more than half an hour.
The pain can be felt all around your knee, or just in a certain place such as the front and sides. It might feel worse after moving your knee in a particular way, such as going up or down stairs.
Sometimes, people have pain that wakes them up in the night. Youll probably find that the pain varies and that you have good and bad days.
You might find you cant move your knee as easily or as far as normal, or it might creak or crunch as you move it.
Sometimes your knee might look swollen. This can be caused by two things:
- Hard swelling: when the bone at the edge of the joint grows outwards, forming bony spurs, called osteophytes .
- Soft swelling: when your joint becomes inflamed and produces extra fluid, sometimes called an effusion or water on the knee.
Sometimes osteoarthritis of the knee can cause the muscles in the thighs to weaken, so your leg may look thinner. This weakness can make the joint feel unstable and could cause the knee to give way when you put weight on it.
Arthritis With Involvement Of The Soft Tissues
It can happen that the inflammatory process present in the joints of the leg extends to the soft tissues, aggravating the present symptomatology .
When this happens, the whole dynamics of the leg is affected and the patient is prevented from engaging in daily living activities.
This type of arthritis is common in those who have overused their joints for example, professional athletes, runners, joggers. Physical injuries can trigger the appearance of this form of arthritis as well.
The inflammatory process can stem from the soft tissues as well, affecting the joints as consequence. In making the diagnosis of arthritis, it is important to diagnose the root of the problem and treat it accordingly.
If the leg pain is severe, involving a large surface and being resistant to medication, the condition one is suffering from might be fibromyalgia.
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What Does Constant Calf Pain Mean
A moderate injury, such as a strain, or leg cramps are frequently the cause of calf muscle discomfort. The presence of severe or persistent discomfort in your calves, however, may indicate that the muscles in your lower legs are not receiving enough blood. Appointments can be made by calling 216.444.2606.
What Can Be Some Of The Causes Of Achilles Tendonitis
- As mentioned athletic activities such as Football, basketball, tennis, running any form of overuse.
- Inadequate footwear when playing sport. No matter whether your sport is recreational or professional it pays to spend a little more and purchase good footwear that is going to give you adequate ankle support. Even if you are not a sports person, it was always drummed into me as a kid that good footwear was important for healthy, growing feet and of course your ankles.
- Lack of Flexibility keeping your feet and ankles flexible with stretching exercises and rotating your ankles helps to keep up the blood flow.
- Diet high in salt, sugar and soft drinks will create rigidity within your joints, including your tendons.
- Overweight and obesity being overweight places more strain on many parts of the body, including the Achilles tendon.
- Quinolone antibiotics it has been recognized that in some instances there has been inflammation occurring with tenosynovitis after taking this prescribed medication.
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Popliteus And Plantaris Muscle Injuries
The back of the knee is also where deeper muscles, like the popliteus and plantaris, live . The popliteus muscle crosses from the inside bottom back of the knee to the outside top of the knee. The plantaris muscle bridges directly behind the knee and terminates at its tendon, which stretches all the way down to the Achilles tendon at the back of the heel.
If there is a problem with either of these, you will feel back of knee pain and tightness deeper into the knee when you massage or put pressure there. With the popliteus muscle, you might also experience the knee locking up, and addressing this muscle could be the key to unlocking the knee as well as eliminating your back of knee pain.
How To Treat And Care For Achilles Tendonitis
The main focus here is to reduce strain and stress on the tendon and to support the inflammation process:
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What Causes Achilles Tendinitis
In Achilles tendinitis, overuse of the Achilles tendon causes swelling, irritation and inflammation. You can get Achilles tendinitis by being active on your feet. Its usually not related to a specific injury it happens because of stressing the tendon repeatedly. Because its difficult to avoid using the Achilles, the body doesnt have time to repair the injured tissue.
What Makes Me Susceptible To Arthritis Of The Knee
Inherited bone structure or genetic mutations can contribute to the development of knee arthritis, as well as repetitive injury from a profession or sports. Age-related arthritis becomes common after 45 years of age.
Weight is also a factor, since the knee bears much of the bodys weight. The constant pounding pressure that is placed on the knee when walking, which becomes greater with more weight, causes the cartilage in the joint to break down over time. When the cartilage disintegrates, bone-on-bone scraping occurs whenever you move your leg.
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What Is Hip And Leg Pain
Hip and leg pain can have many different causes. Because the movement of the hip joint, lower back, and leg bones are all connected, pain or inflammation in one area can cause problems in another. This is called referred pain.
Types of damage or injury that could be causing hip and leg pain are:
- Bone fractures.
- Nerve damage. Damage to the nerves can lead to neuropathy , a tingling sensation radiating into the legs and extremities.
- Muscle injury or inflammation . Muscle sprains, tears or strains in the lower back, buttocks, pelvis, and thighs can cause hip and leg pain.
- Joint problems.Arthritis can lead to pain in the hip, lumbar or lower spine, and the knee, causing pain that can be felt throughout the lower body.
How Can I Take Care Of Myself If I Have Achilles Tendinitis
Achilles tendinitis can be frustratingly slow to heal. It can take time for your symptoms to disappear completely. Follow your healthcare providers instructions, so you dont re-injure the tendon and worsen the symptoms.
If youre trying nonsurgical treatments to avoid or delay surgery, expect to wait a few months to see improvement. To keep the tendon healthy:
- Attend physical therapy.
- Avoid certain activities or sports.
- Stretch the muscle.
If youre recovering from surgery, follow your providers instructions for the recovery period:
- Attend physical therapy.
- Do range-of-motion exercises to keep the tendon moving.
- Wear your cast, splint or boot for the required period.
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When Should I Call A Healthcare Provider About My Achilles Tendons
If you still experience pain and symptoms three to six months after you start treatment, you should talk to a healthcare provider. In some cases, severe Achilles tendonitis can lead to an Achilles tendon rupture, which requires surgery.
A note from Cleveland Clinic
Your Achilles tendon connects your calf muscles to your heel bone. Though the Achilles tendon is strong, people frequently experience Achilles tendon injuries. Conditions that impact the Achilles tendon include bursitis, tendinitis, tendinosis and tendon rupture. Providers treat most Achilles tendon issues nonsurgically, though tendon rupture often requires surgery. With proper rest and activity, many Achilles tendon injuries heal within three to six months.
Last reviewed by a Cleveland Clinic medical professional on 09/24/2021.
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What Else Should I Know
With rest, Achilles tendonitis usually gets better within 6 weeks to a few months. To lower your risk of Achilles tendonitis again:
- Stay in good shape year-round. Drink plenty of water to flush out inflammation, and eat healthy whole grains, vegetables, and fruits to decrease inflammation.
- Increase the intensity and length of your exercise sessions gradually. Experts recommend just a 10% increase in activity per week. This is especially important if you’ve been inactive for a while or you’re new to a sport.
- Always warm up before you go for a run or play a sport and cool down by stretching after.
- Stretch your legs, especially your calves, hamstrings, quadriceps, and thigh muscles. After activity, hold your stretches for 30 seconds and repeat several times a day.
- Wear shoes that fit properly and are made for your sport. Replace them before they become worn out.
- Try to run on softer surfaces, like grass, dirt trails, or synthetic tracks. Hard surfaces like concrete or asphalt can put extra pressure on the joints. Also avoid running up or down hills as much as possible.
- Do different kinds of exercise, such as yoga, biking, and swimming. Work different muscle groups to keep yourself in good shape overall and to prevent overusing individual muscles.
If things don’t improve, see your doctor, as it may be a sign that you have a different condition.
What Are Common Tests To Check The Health Of Your Achilles Tendon
Your healthcare provider first does a physical exam to check for Achilles tendinopathy. Your provider looks for Achilles tendon pain when they move or press your tendon.
They examine the area around your heel and lower leg for:
- A knot on the back of the leg or bruising over the tendon .
- Swelling, tenderness, redness or warmth .
- Thickening or small bumps .
Your healthcare provider may also use tests including:
- Thompson test : If your foot doesnt flex downward when your provider presses your calf, you may have an Achilles tendon rupture.
- Matles test : If the toe end of your foot doesnt point away from your leg when your provider bends your knee at a right angle, you may have an Achilles tendon rupture.
- Magnetic resonance imaging : Your provider can see detailed images of your leg and ankle. These images can help diagnose an Achilles tendon rupture and other Achilles problems.
- Ultrasound : Your provider can scan images of your Achilles tendon to look for a tendon rupture.
- X-rays: Your provider may take X-rays of your foot to check for problems related to tendinopathy, such as degeneration or bone spurs. They can also use X-rays to find hardening of the lower part of the Achilles tendon, a sign of tendinitis.
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What Are The Complications Of Achilles Tendon Injuries
Complications of an Achilles tendon injury may include:
Pain, which can be severe
Difficulty walking or being active
Deformation of your tendon area or heel bone
Tendon rupture from reinjury
Other complications can be related to the treatments used for an Achilles tendon injury. For instance,
Occasionally, cortisone injections can cause the tendon to tear
Surgery can lead to pain and infection
How Is Achilles Tendon Pain Treated
Patients with Achilles pain do not always require tendon repair surgery. Frequently, a combination of rest and anti-inflammatory painkillers , together with a personalised rehabilitation programme of physiotherapy will relieve the pain.
Your consultant may advise a course of steroid injections to control the inflammation. For conditions like insertional Achilles tendinitis, it can be beneficial to wear heel lifts to remove strain from the tendon. Specially designed supportive walking boots can also be useful.
Should the tendon pain not respond to treatment, your consultant may advise that an operation to remove any bone spurs is necessary. If the tendon is in a very poor condition, tendon transfer surgery, involving the relocation of another tendon in the foot to support the damaged Achilles tendon, is another option.
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