Achilles Tendinitis / Tendinopathy
Achilles tendon or Calcaneal tendon is a tough band of fibrous tissue at the back of the lower leg which attaches the calf muscles to the heel bone. It is the thickest tendon in the human body and is responsible for Plantar flexion of the foot at the ankle joint.
Involvement of Achilles tendon is most common in runners who have suddenly increased the intensity or duration of their runs. It's also common in middle-aged people who play sports, such as tennis or basketball, only on the weekends.
Various abnormalities that can affect Achilles tendon include
- Achilles tendinitis: Inflammation of the tendon
- Achilles tendinopathy: Degeneration of the tendon due to overuse
- Achilles tendon Rupture : Discontinuation in the tendon due to injury
- Calcific or Lipid enthesiopathy: Calcium or fat deposition in the tendon
Signs/Symptoms of Achilles Tendinitis/Tendinopathy
- Pain and tenderness at the back of the heel.
- May be associated with swelling at the back of the heel
- Aggravation of pain on standing for long duration or after running or any sports activity
- Limited range of motion of ankle due to pain
- Thickening of the tendon with s/o degeneration on Ultrasound examination
- s/o peritendinous fluid collection
Risk Factors
- Sudden change in the schedule or intensity of any sports activity like running
- Excessive training putting increased stress on the tendon and causing multiple micro-traumas like running on hills
- Deformities of foot arches like Flat foot or High arched foot
- Chronic ankle instability
- Use of high heels
- Consumption of certain antibiotics like Fluoroquinolones puts a person at temporary risk of tendon injury
- Certain arthritic conditions like Ankylosing spondylitis or Psoriatic arthritis, predispose patients to Achilles tendon abnormalities
JEEVISHA protocol for management of Achilles tendinitis/Tendinopathy
- Foot posture correction: As this condition mostly occurs due to undue stress on the tendon, Foot posture analysis and correction becomes of paramount importance. At JEEVISHA, we have various modalities to measure the degree of foot deformities and also facilities like Individualised In-sole preparations.
- Medications: In the initial course of the management of this condition, patients may be prescribed some Anti-inflammatory medications. Some other medications may be prescribed depending on the condition of the patient, which is individualized from patient to patient basis.
- Physiotherapy: Physiotherapy plays a very important role in fighting this painful condition. With a team of dedicated physiotherapist, patient is further evaluated and accordingly a plan is prepared for first reducing pain with different modalities and then slowly rehabilitating ankle for normal functioning.
Targeted treatment
- Ultrasound guided Peri-tendinous injection
- Ultrasound guided Dextrose prolotherapy
- Ultrasound guided Platelet rich plasma Prolotherapy
- Ultrasound guided barbotage of calcific deposits.