Achilles Tendinopathy

ACHILLES TENDINOPATHY 

Heel pain can have many causes , and achilles tendinopathy is a common cause of heel pain.

In this blog will share more knowledge about this condition and how to cure it.

ACHILLES TENDENOPATHY

The Achilles tendon is the largest tendon in the body. It connects the calf muscles to the heel bone and is used when you walk, run, climb stairs, jump, and stand on your tip toes. Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendinitis, a condition associated with overuse.

Simply defined, tendinitis (also spelled "tendonitis") is acute inflammation of a tendon. Inflammation is the body's natural response to injury and often causes swelling, pain, or irritation.

You may also come across the term "tendinopathy," which is used to describe a condition in which the tendon develops microscopic degeneration as a result of chronic damage over time. Tendinitis, tendinosis, and tendinopathy are all common terms which essentially refer to the same problem.

Achilles tendinitis is different than an Achilles rupture, a condition where the tendon becomes separated off the heel bone or completely torn in half. Achilles tendon rupture typically results from a sudden injury. This article will focus on Achilles tendinitis rather than Achilles tendon rupture.

There are two types of Achilles tendinitis, based on which part of the tendon is inflamed. The two types can occur separately or at the same time.

Noninsertional Achilles Tendinitis

Noninsertional Achilles tendinitis

In noninsertional Achilles tendinitis, fibers in the middle portion of the tendon (above where it attaches to the heel) are affected. Over time, the fibers may begin to break down and develop tiny tears. This can lead to tendon swelling and thickening.

Noninsertional tendinitis more commonly affects younger, active people, especially runners.

Insertional Achilles Tendinitis

Insertional Achilles tendinitis

Insertional Achilles tendinitis involves the lower portion of the tendon, where it attaches (inserts) to the heel bone (also known as the calcaneus).

In both noninsertional and insertional Achilles tendinitis, damaged tendon fibers may calcify (harden) over time. Bone spurs often form on the heel with insertional Achilles tendinitis.

Insertional Achilles tendinitis can occur at any time or activity level, although it is still most common in runners. It is frequently caused by calf muscle tightness, which places increased stress on the Achilles tendon insertion.

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Cause

Achilles tendinitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too quickly. Other factors can also make a person more likely to develop Achilles tendinitis, including:

• A sudden increase in the amount or intensity of exercise activity. For example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance may cause irritation and inflammation.
• Tight calf muscles. Calf muscle tightness puts extra stress on the Achilles tendon, especially where it inserts into the heel bone.
• Haglund's deformity. This is a condition in which there is enlargement of the bone on the back of the heel. This can rub on the Achilles tendon and cause inflammation and pain.

Haglund's deformity is when there is abnormal bone growth near where the Achilles tendon attaches to the heel bone.

Symptoms :

Common symptoms of Achilles tendinitis include:

• Pain and stiffness along the Achilles tendon in the morning
• Pain along the tendon or back of the heel that worsens with activity
• Severe pain the day after exercising
• Thickening of the tendon
• Bone spur formation (insertional tendinitis)
• Swelling that is present all the time and gets worse throughout the day or with activity
• Pain on the back of the heel when you wear shoes

If you have experienced a sudden pop in the back of your calf or heel, you may have torn your Achilles tendon. See your doctor immediately if you think you may have torn your tendon.

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INVESTIGATION

• MRI
• ULTRASOUND

Treatment

Nonsurgical Treatment

In most cases of Achilles tendinitis, nonsurgical treatment options will provide adequate pain relief, although it may take a few months for symptoms to completely subside. Even with early treatment, the pain may last longer than 3 months.

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PHYSIOTHERAPY MANAGEMENT

Physical therapy is very helpful in treating Achilles tendinitis. 

Rest

The first step in reducing pain is to decrease or even stop the activities that make the pain worse. If you regularly participate in high-impact exercises (such as running), switching to low-impact activities will decrease the amount of stress on the Achilles tendon. Cross-training activities such as biking, elliptical exercise, and swimming are low-impact options to help you stay active. Your doctor may recommend an ankle brace or boot immobilization to help with this step.

Ice

Placing ice on the most painful area of the Achilles tendon is helpful and can be done as needed throughout the day. This can be done for up to 20 minutes at a time, but the ice should be removed sooner if the skin becomes numb.

A foam cup filled with water and then frozen creates a simple, reusable ice pack. After the water has frozen in the cup, tear off the rim of the cup. Then rub the ice on the Achilles tendon. With repeated use, a groove that fits the Achilles tendon will appear, creating a custom-fit ice pack.

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The following exercises and stretches can help to strengthen the calf muscles and reduce stress on the Achilles tendon.

Calf stretch

Calf stretch. Lean forward against a wall with one knee straight and your heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. You should feel a strong pull in the calf during the stretch.

Eccentric Strengthening. Eccentric strengthening is defined as contracting (tightening) a muscle while it is getting longer. Eccentric strengthening exercises can cause damage to the Achilles tendon if they are not done correctly. At first, they should be performed under the supervision of a physical therapist. Once mastered with a therapist, the exercises can then be done at home. These exercises may cause some discomfort, but it should not be unbearable:

Heel drop

• Bilateral heel drop
  Stand at the edge of a stair, or a raised platform that is stable, with just the front half of your foot on the stair. This position will allow your heel to move up and down without hitting the stair. Care must be taken to ensure that you are balanced correctly to prevent falling and injury. Be sure to hold onto a railing to help you balance.
  
  Lift your heels off the ground then slowly lower your heels to the lowest point possible. Repeat this step 20 times. This exercise should be done in a slow, controlled fashion. Rapid movement can create the risk of damage to the tendon. As the pain improves, you can increase the difficulty level of the exercise by holding a small weight in each hand.

• Single leg heel drop
  This exercise is performed similarly to the bilateral heel drop, except that all your weight is focused on one leg. This should be done only after the bilateral heel drop has been mastere.

TRANSARTERIAL MICRO EMBOLIZATION

Transarterial microembolization (or Transcatheter Arterial Embolization, TAE) is a minimally invasive procedure for chronic Achilles tendinopathy that targets and blocks abnormal new blood vessels (neovascularization) that contribute to inflammation and pain. During the procedure, an interventional radiologist guides a catheter through an artery to the Achilles tendon and injects an embolic agent to cut off the blood supply to these pathological vessels, which can significantly reduce pain and inflammation. Studies suggest TAE has a good safety profile and shows promising results, with patients reporting pain reduction in 86% of cases in one pilot study, though more randomized controlled trials are needed to confirm these benefits.

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BENEFITS

• Minimally Invasive:

A small puncture site is used for catheter insertion, resulting in a faster recovery compared to surgery.

• Reduces Pain:

The procedure aims to reduce inflammation and pain by targeting the vascular supply of the affected tissue.

• Novel Approach:

It offers a novel, non-surgical option for patients whose tendinopathy does not respond to conservative treatments.

• Effective in Chronic Cases:

Studies have shown it can be effective for both insertional and non-insertional tendinopathy, including in athletes.

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POSITIVE OUTCOMES:

A pilot study of 20 patients showed an 86% success rate (at least a 50% reduction in pain score) at 6 months after embolization.

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GRADUAL IMPROVEMENT:

Many patients notice improvement within the first few weeks, with continued pain relief in the months following the procedure.

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    LOW ADVERSE EVENTS:

Studies have indicated a good safety profile with a low rate of minor side effects.