Achilles Tendonitis, Tendonosis and Ruptures in Runners

September 12, 2011 Posted by Dr.Chang

The Achilles Tendon connects [KB1] the calf muscle to the heel bone and is the thickest and strongest tendon in the human body. While helping raise the foot off the ground with each step, the Achilles tendon can receive a load stress 3.9 times body weight during walking and 7.7 times body weight when running. Despite its colossal strength, the Achilles tendon is prone to injury (we can blame Thetis for that). Injuries can be due to certain unique characteristics of the Achilles tendon – the load stress it takes with each stride, the lack of a proper tendon sheath, and general poor blood supply to the area. Furthermore, as Dr. Pributt writes, “besides the heart, the calf is the hardest working muscle of the body,” and the Achilles is the anchor that enables the calf to work.

Runners are particularly susceptible to Achilles injuries. Part of the reason for that is that runners are often passionate about what they do, strong-willed, accustomed to enduring pain, and high achieving. This combination makes us runners on one hand dedicated to our sport, and on the other, neglectful when our bodies need rest. To be sure, pushing our bodies beyond our ability level for too long, or when parts are hurting, can cause injuries, can worsen injuries, and can lead to long periods of time off the track, pavement or trails. Because of this, by reading about injuries – such as those to the Achilles – and by recognizing how quickly little aches can turn into prolonged injuries, us runners can heed a wise warning: listen to your body, and contact you local podiatrist when you are experiencing foot or ankle pain. Dr. Murray and Dr. Chang of Blue Ridge Foot and Ankle have worked with runners for two decades, and can help you in both preventing aches and pains from getting worse and in healing from injuries.

The most common Achilles injuries are Achilles tendonitis and tendonosis, the former being the inflammation of the Achilles tendon and the latter being degeneration of Achilles tendonitis. The inflammation from Achilles Tendonitis is usually short-lived. Over time, if tendonitis is not treated, it can degenerate into a worse condition called tendonosis, marked by tears in the tendon. In rare cases, chronic degeneration with or without pain may result in a rupture of the tendon.

The most common risks to the Achilles are sudden increases of repetitive activity without giving the Achilles tendon the proper time to repair itself from the micro-injuries to the tendon fibers that result from intense activity. Athletes and runners with inconsistent workout schedules, such as weekend warriors and those who increase their workout intensity and volume too quickly, are prone to Achilles injuries. Additionally, Achilles injuries may be due to physiological reasons such as excessive pronation and flat feet, which put extra pressure on the tendon.

Achilles tendonitis and tendonosis will result in pain, aching and tenderness along the tendon’s path, increasing when the sides of the tendon are squeezed but with less pain in the back of the tendon. To diagnose Achilles injuries, your podiatrist will examine the foot, its range of motion, and conduct further assessment with imagining techniques such as X-rays or MRIs.

Treatment plans will focus on reducing force on the Achilles tendon by means of a cast or walking boot, reducing swelling with ice and oral medications, long term preventative strategies such as over the counter and custom orthotics and night splints, and gradually building a physical therapy regimen that includes stretching and strengthening exercises, soft-tissue massage and mobilization, and ultra-sound therapy.

One major factor in Achilles injuries is excessive tightness of the posterior leg muscles and even connected tendons, so physical therapy and long term maintenance will include light calf stretches, hamstring stretches, and plantar stretches after warming up, to ensure the health of your Achilles. You may even want to consult your podiatrist and physical therapist about working on your gait and stride while running, as gait abnormalities can lead to Achilles tendon and other injuries.  Your training plan might need to be altered – working out for fewer hours per week, cutting down on speed work, hill repeats, strengthening and plyometric work, and avoiding excessive stretching. Specific methods of taping may also help to take pressure off the Achilles and to increase blood flow to the affected area.

Additionally, your doctor will suggest the proper footwear for you to recover or point you toward shoe experts. For example, soft cushioned soles or air filled heels can contribute to Achilles injuries since they make the foot sink lower in the shoe to absorb the shock of heel strike, thereby stretching the Achilles tendon with each stride more than a firm-soled shoe would. Your local shoe dealers, Ragged Mountain Running, the Charlottesville Running Company and Richey and Co. Shoes, can all provide foot assessments and expert advice about properly fitting shoes.

Achilles tendon ruptures are partial or complete tears of the Achilles tendon. Because of the Achilles physiology, they are completely debilitating. Rupturing ones Achilles is often described as a painful and abrupt popping, even as a ‘gun-shot’ to the ankle. If such a sensation occurs, it’s time to visit your doctor. Immediately. Achilles ruptures are serious, and seriously debilitating, injuries.

Achilles ruptures occur when the tensile force on the Achilles tendon exceeds its tensile strength. Ruptures can be caused by traumatic events or sudden over stretching, but Achilles degeneration is usually seen in patients who experience Achilles rupture so a combination of traumatic events and degeneration is most common among rupture injuries. The rupture sites commonly occur 2-6 cm above the junction between the Achilles and the calcaneus bone (the heel bone), which is the point at which the Achilles receives the least amount of blood supply. This very lack of blood supply, unfortunately, makes it extremely difficult to heal Achilles ruptures.

Physical examinations of Achilles ruptures often reveal gaps in the tendon at the site of the rupture. The Achilles will often be swollen, red, hot and painful. Additionally, the foot will have a difficult time plantar flexing even without pressure on the tendon and surrounding muscles. Your doctor will do diagnostic testing that can include a physical exam, ultrasounds, and MRIs. Achilles ruptures are usually treated with surgery. This surgery will effectively stitch the lesion in the tendon.

Brace yourself – after an Achilles rupture you’re in for a long recovery. Achilles injuries are often followed by at least 12 weeks of casts, braces and splints. Current research suggests that, depending on the degree of injury and individual constraints, early motion can be an acceptable form of rehabilitation (which would include light physical therapy immediately after the surgery). In either case, your podiatrist will probably suggest that you wear a heel lift for up to one year after the removal of the cast. In recovery, a range of care will be required that includes physical therapy, icing, taping, non-steroidal anti-inflammatory drugs. Consult your podiatrist for the appropriate treatment plan for your ankle pain.

Achilles injuries are no walk in the park, especially because they are progressive injuries. Catching and treating Achilles injuries early is key to healing successfully. Once you start feeling Achilles pain do not ignore it. Visit your Charlottesville and Waynesboro podiatrists, and they can help you construct a treatment plan and all sorts of preventative exercises that are right for your individual injury. In many cases, there are preventative measures within your control before a severe Achilles injury stops you from running or engaging in your day-to-day activities.

Listen to your body. Treat foot and ankle pain with the help of your local Charlottesville or Waynesboro foot doctor so that you can get back to the activities that you love.

Comment on this post to share your Achilles story or contact Blue Ridge Foot and Ankle Clinic. We’d love to hear from you!

Blue Ridge Foot and Ankle Clinic

              Charlottesville Podiatrist Location: 887 A Rio E Ct., Charlottesville VA, 22911 (434) 979-8116

Waynesboro Podiatrist Location: 417 S. Magnolia Waynesboro,VA 22980 540-949-5150

Blue Ridge Foot and Ankle Clinic has been a part of the Waynesboro and Charlottesville communities for over 20 years. Podiatrists Dr. Kevin Murray and Dr. Stewart Chang offer services in sports podiatry, foot and ankle problems and diabetic foot care. Our friendly, accommodating team of Certified Podiatric Medical Assistants look forward to welcoming you to our practice.

 

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