What is the Achilles tendon?

The Achilles tendon was first documented as such in 1693 by a Flemish/Dutch anatomist, Philip Verheyen. Otherwise known as the heel cord or the calcaneal tendon, the Achilles tendon is the thickest and strongest tendon in the body. Located at the back of the lower leg, the Achilles tendon connects the calf muscle to the bone in your heel and is responsible for the majority of your foot and leg movement. When your calf muscle contracts, it engages the Achilles tendon to lift the foot. So, as you can presume, the Achilles tendon plays a vital part in your ability to walk, run, jump, stand on your tiptoes and climb stairs. Because the Achilles tendon is so integral to your everyday life, overuse leading to Achilles tendinitis is very common.

GREEK MYTHOLOGY

The name Achilles tendon is derived from the Greek hero, Achilles, of the Trojan War, the greatest of all the Greek warriors. But why? It’s written in Greek Mythology that when this mighty warrior was an infant his mother held him by one of his heels and dipped him in the river Styx, a river that formed the boundary between Earth and the Underworld. This was to make him invulnerable everywhere the water touched him, neglecting the heel his mother held him by. In the end, an arrow to that very heel would be the cause of his ultimate demise. As this legend suggests, the term “Achilles heel” came to refer to a point of weakness, particularly in someone or something with otherwise great strength and conviction. 

 

What is tendinitis?

Tendinitis happens when the tissue that connects muscles to bone becomes inflamed. Your Achilles tendon can stretch or tear with overuse, causing swelling, redness, and irritation to the back of your leg.

Achilles tendinitis is separated by two different types of injuries:

  • Non-insertional: The non-insertional injury affects the middle of your tendon.

  • Insertional:  The insertional injury affects where your tendon connects to the heel bone.

Do I have Achilles tendinitis?

You may notice symptoms of Achilles tendinitis show up as pain in the back of your leg, usually close to your heel, and your legs may feel stiff or weak. Inflammation of your tendon increases with physical use and lessens with rest.

Starting a new exercise regimen, not stretching before exercise, and repeated hard impacts from activities like running or jogging aggravate your Achilles tendon and cause tendinitis pain and discomfort.

 

How can I treat Achilles tendinitis?

COMMON TREATMENTS
  • Rest
  • Ice
  • Over-the-counter anti-inflammatory medication
  • Therapeutic exercise is 1 of the mainstays of treating the Achilles tendon.  These include gentle stretching, eccentric contractions,  and massage.
  • Certain exercises
  • Night splints
  • Change of footwear
ADVANCED TREATMENTS

More advanced treatment for Achilles tendon disease include:

Nutritional Support: Tissues need nutrition to heal.  Frequently, this is an angle acted aspect of the treatment for Achilles   Tendinopathy.  

Transdermal Nitroglycerin Patches: Some studies have shown the transdermal nitroglycerin patches can significantly decrease  pain and  decreased healing time by using this product.  This causes a vasodilation to increase blood supply  to a tendon that is for the most part dysvascular.  This increased blood supply seems to be helpful and speeding the healing.

Surgical Intervention: Surgical intervention can consist of many things.  There are simple procedures with short recoveries that can make a huge difference.  Recently in our clinic we have stopped doing major reconstructions on the Achilles tendon as a primary treatment when surgery is considered.  The reason for this is because the recoveries are quite long and difficult.  There are other surgeries that take stress off the tendon that have a relatively short recovery.   For example minimally invasive ultrasonic hydro tenotomy or just simple minimal tendon lengthening.  These have become quite common in our clinic for patients with chronic Achilles tendinopathy that has not responded to conservative care.  

 

NEWER TREATMENTS

Even newer therapies that have been introduced in the last 10-15 years that also have shown significant improvements in treating Achilles tendon, including:

These have shown significant promise in medical literature if appropriately used.  Unfortunately these advanced therapies are not lightly available in most clinics because of the significant cost involved. At the Next Step Foot and Ankle Clinic we are very happy to have access to all of these 21st Century treatments for Achilles tendon disease. 

In rare cases, your doctor may recommend corrective surgery to either lengthen your tendon or remove the damaged portion. Luckily, here at Next Step Foot & Ankle Clinic Dr. Silvester, Dr. Bills and Dr.Larsen take pride in their continued education and are constantly expanding their knowledge base. Allowing them to offer you new and innovative minimally invasive treatments and surgical techniques.

 

How can I prevent an Achilles tendinitis strain?

Preventing tendinitis is difficult, but reducing your risk of injury is your best prevention technique.

Some ways to reduce your risk of injury are:

  • Increase activity slowly
  • Rest when appropriate
  • Wear supportive shoes
  • Stretch before physical activity, focusing on your calf muscles
OUR DIAGNOSTIC MEASURES

Patient history and clinical exam:

Probably the most important considerations and diagnosing the degree of Achilles tendon disease is the patient history and the clinical exam.  How long the disease has been present, the degree of pain, the tenderness and location of pain are all considerations in diagnosing the Achilles Tendon disease.  

X-Rays

X-rays can be helpful to diagnose whether or not bone spurs or calcification has occurred within the Achilles tendon.  These do not necessarily have to be removed.  But they are an indication of the degree of disease.  

Ultrasound:  

Ultrasound evaluation in the office is  an inexpensive and effective way to evaluate the Achilles tendon.  Ultrasound can see many things including longitudinal tears, degenerative defects, calcification, soft tissue inflammation of the lining of the tendon, and partial ruptures.  It is equally effective as MRI in many of these diagnostic areas.  

MRI:  

MRI is a more expensive test that shows very good detail of the tendon and also the bone underneath the tendon.  Frequently, both of these structures are involved in the disease.   In our clinic it is quite common we do not order an MRI immediately because of the cost of the study. 

 

Achilles tendinitis is a common overuse problem, but with the correct treatments and preventive measures, you can return to your active self stronger than before your injury with the help of Next Step Foot & Ankle Clinic.

If you live in the San Antonio area, book your appointment online or call one of the two offices in Pleasanton or Universal City, Texas.

 

the Next Step Difference