Cure for Achilles tendonitis

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

The Achilles tendon is fibrous band that connects the heel to the calf muscles.

The Achilles tendon is the thickest and strongest tendon in the body. Contracting the calf muscles pulls the Achilles tendon, which causes the toes to point down. This movement permits standing on the toes, walking, running, and jumping. Depending on the stress applied for different activities, the Achilles tendon may be exposed to 3-12 times a person’s body weight during a run or push off maneuver.

The most common Achilles tendon injuries are Achilles tendinosis (sometimes referred to as Achilles tendonitis) and Achilles tendon rupture. Achilles tendinosis is a degeneration of tendon fibers that leads to soreness and pain in the tendon. Achilles tendinosis is a common injury among runners and other athletes. However, it can also occur in people who aren't particularly athletic but who have done something to strain the tendon.

Achilles tendon rupture is a partial or complete tear of the Achilles tendon. It comes on suddenly, usually with a "popping" sound. Partial and full Achilles tendon ruptures are most likely to occur in sports requiring sudden movements requiring calf contraction, such as sprinting and racket sports.

Partial Achilles tendon tears are also common among joggers. Achilles tendon ruptures are most likely to occur in middle aged athletes who are not in good shape or who fail to use proper stretching techniques.

It is sometimes difficult to distinguish between Achilles tendinosis and a partial Achilles tendon tear. An MRI scan or diagnostic ultrasound can confirm the diagnosis.

The best treatment is prevention. Stretching the Achilles tendon before exercise will help to maintain flexibility. Abnormal foot mechanics can be corrected with orthotics. Proper footwear can be one of the keys to preventing re occurrence of Achilles tendon injuries. Some find temporary benefit from a little extra padding or cushioning under the heel. This reduces the length of Achilles tendon stretch. Occasionally, motion control (anti-pronation) shoes are helpful.

Other conservative measures used to treat Achilles tendonitis include icing the injury, anti-inflammatory medications, and physical therapy.

Resting the painful Achilles tendon will allow for healing. Steroid injections should not be used in the case of Achilles tendonosis because studies have shown an increase in incidence of Achilles tendon rupture after steroid injections.

More recently, a minimally invasive procedure called percutaneous needle tenotomy with autologous tissue grafting has been used to heal Achilles tendonitis. With this procedure, a small needle is inserted under ultrasound guidance using local anesthetic. Multiple small holes (tenotomy)are made in the tendon to stimulate bleeding and inflammation. Platelet rich plasma (platelets are blood cells that contain multiple growth and healing factors), obtained from a specimen of whole blood from the patient, is then injected into the area which has undergone tenotomy. Limited weight-bearing is prescribed for about a week and then physical therapy is started. Patients do extremely well. This procedure is, in my opinion, the procedure of choice for patients who have chronic tendonitis or even small partial tears where surgery is probably not warranted.

Achilles tendon rupture is generally treated surgically to reattach the tendon to its normal position. In some individuals, generally people who live sedentary lifestyles, surgery may be avoided by casting the Achilles tendon rupture for several months. However, the rate of re-rupture is much higher in the non-surgical patients. In patients who have surgery for an Achilles tendon rupture, less than 3% experience a re-rupture of the tendon.

The most common complication following an Achilles tendon repair is problems with wound healing. The skin over the Achilles tendon sometimes does not heal well because the blood supply in this area is not very good. Careful wound management is important following surgical repair of an Achilles tendon rupture.

Patients are placed in a cast following the surgery for a period of 4-8 weeks. The cast will be placed with the toes pointing slightly down. After the cast is removed, a walking boot can be used. This places less tension on the Achilles tendon to permit healing.

For more information about tendonitis, visit our sister site: Tendonitis And PRP

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