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Achilles tendonitis
AchillestendonitisisinflammationoftheAchillestendon.Inmostcases,itisatypeofoveruse injuryandismorecommoninyoungerpeople.Professionalandweekendathletescansufferfrom Achillestendonitis,butitisalsoacommonoveruseinjuryinpeoplenotinvolvedinsport. Treatmentincludesrest,non-steroidalanti-inflammatorydrugs(NSAIDs),physicaltherapyand avoidingactivitiesthataggravatethecondition. Tendons explained Atendonisabandofconnectivetissuethatanchorsmuscletobone.TheAchillestendonisthe largesttendoninthebody.Itattachesthecalfmusclestotheheelbone(calcaneus)andisvery importantbecauseitletsyouliftyourheelwhenyoustarttowalk.Italsohelpsyoutowalk,runor standontiptoe. Symptoms SymptomsofAchillestendonitisinclude: Paininthebackoftheheel Difficultywalkingsometimesthepainmakeswalkingimpossible Swelling,tendernessandwarmthoftheAchillestendon.

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Degrees of severity Achillestendonitisisgradedaccordingtohowsevereitis: MildpainintheAchillestendonduringaparticularactivity(suchasrunning)orshortly after. ModeratetheAchillestendonmayswell.Insomecases,ahardlump(nodule)mayform inthetendon. SevereanytypeofactivitythatinvolvesweightbearingcausespainoftheAchilles tendon.VeryoccasionallytheAchillestendonmayrupture(tear).WhenanAchillestendon ruptures,itissaidtofeellikeahardwhackontheheel.

Common causes SomeofthecausesofAchillestendonitisinclude: Overuse injurythisoccurswhentheAchillestendonisstresseduntilitdevelopssmall tears.Runnersseemtobethemostsusceptible.Peoplewhoplaysportsthatinvolve jumping,suchasbasketball,arealsoatincreasedrisk. ArthritisAchillestendonitiscanbeapartofgeneralisedinflammatoryarthritis,suchas ankylosingspondylitisorpsoriaticarthritis.Intheseconditionsbothtendonscanbe affected. Foot problemssomepeoplewithflatfeetorhyperpronatedfeet(feetthatturninward whilewalking)arepronetoAchillestendonitis.Theflattenedarchpullsoncalfmusclesand keepstheAchillestendonundertightstrain.Thisconstantmechanicalstressontheheel andtendoncancauseinflammation,painandswellingofthetendon.Beingoverweightcan maketheproblemworse. Footwearwearingshoeswithminimalsupportwhilewalkingorrunningcanincreasethe risk,ascanwearinghighheels. Overweight and obesitybeingoverweightplacesmorestrainonmanypartsofthe body,includingtheAchillestendon.

Diagnosis Toconfirmthediagnosisandconsiderwhatmightbecausingtheproblem,itsimportanttosee yourdoctororaphysiotherapist.Methodsusedtomakeadiagnosismayinclude:

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Medicalhistory,includingyourexercisehabitsandfootwear Physicalexamination,especiallyexaminingforthicknessandtendernessoftheAchilles tendon Testsmayberequired.Thesemayincludeanx-rayofthefoot,ultrasoundandoccasionally bloodtests(totestforaninflammatorycondition),andanMRIscanofthetendon.

Treatment Theaimofthetreatmentistoreducestrainonthetendonandreduceinflammation.Strainmaybe reducedby: Avoidingorseverelylimitingactivitiesthatmayaggravatethecondition,suchasrunning Usingshoeinserts(orthoses)totakepressureoffthetendonasitheals.Incasesofflator hyperpronatedfeet,yourdoctororpodiatristmayrecommendlong-termuseoforthoses.

Inflammationmaybereducedby: Applyingicepacksfor20minutesperhourduringtheacutestage Takingnon-steroidalanti-inflammatorydrugs Placingthefootinacastorrestrictiveankle-boottominimisemovementandgivethe tendontimetoheal.Thismayberecommendedinseverecasesandusedforabouteight weeks.

Other treatment that may be recommended Youmayalsobegivenspecificexercisestogentlystretchthecalfmusclesoncetheacutestageof inflammationhassettleddown.Yourdoctororphysiotherapistwillrecommendtheseexercises whenyouareontheroadtorecovery.Recoveryisoftenslowandwilldependontheseverityof theconditionandhowcarefullyyoufollowthetreatmentandcareinstructionsyouaregiven. Surgery Surgeryisconsideredthelastresort.Itisonlyrecommendedifallothertreatmentoptionshave failedafteratleastsixmonths.Inthissituation,badlydamagedportionsofthetendonmaybe removed.Ifthetendonhasruptured,surgeryisnecessarytore-attachthetendon. Rehabilitation,includingstretchingandstrengthexercises,isstartedsoonafterthesurgery.In mostcases,normalactivitiescanberesumedafterabout10weeks.Returntocompetitivesportfor somepeoplemaybedelayedforaboutthreetosixmonths. Prevention SuggestionstoreduceyourriskofAchillestendonitisinclude: Incorporatestretchingintoyourwarm-upandcool-downroutines. Maintainanadequateleveloffitnessforyoursport. Avoiddramaticincreasesinsportstraining. IfyouexperiencepaininyourAchillestendon,restthearea.Tryingtoworkthroughthe painwillonlymakeyourinjuryworse. Weargoodqualitysupportiveshoesappropriatetoyoursport.Ifthereisfootdeformityor flattening,obtainorthoses. Avoidwearinghighheelsonaregularbasis.Maintainingyourfootinatiptoeposition shortensyourcalfmusclesandreducestheflexibilityofyourAchillestendon.Aninflexible Achillestendonismoresusceptibletoinjury. Maintainanormalhealthyweight.

Where to get help Yourdoctor Podiatrist Physiotherapist

Things to remember Inmostcases,Achillestendonitisisatypeofoveruseinjurythatismorecommonamong athletesandpeoplewhotrainheavily.

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Treatmentincludesrest,non-steroidalanti-inflammatorydrugs(NSAIDs),physicaltherapy andavoidingactivitiesthataggravatethecondition. Surgeryisonlyconsideredifallothertreatmentoptionshavefailedtocurethecondition withinsixmonths.

This page has been produced in consultation with, and approved by:

AustralianRheumatologyAssociation(VicBranch)

Copyight 1999/2009StateofVictoria.ReproducedfromtheBetterHealthChannel(www.betterhealth.vic.gov.au)at nocostwithpermissionoftheVictorianMinisterforHealth.Unauthorisedreproductionandotherusescomprisedinthe copyrightareprohibitedwithoutpermission. ThisBetterHealthChannelfactsheethaspassedthrougharigorousapprovalprocess.Forthelatestupdatesandmore informationvisitwww.betterhealth.vic.gov.au.

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