Achilles Tendonitis
Achilles tendinopathy (common overuse injury) refers to a combination of pathological changes affecting the Achilles tendon usually due to overuse and excessive chronic stress upon the tendon. It can be seen both in athletes and non-athletes. It may or may not be associated with an Achilles tendon tear. A lack of flexibility or a stiff Achilles tendon can increase the risk of these injuries.
Surgical specimens show a range of degenerative changes of the affected tendon, eg the tendon fiber structure and arrangement; an increase in glycosaminoglycans (water-binding molecules that can hold nearly 1,000 times their own weight), which may explain the swelling of the tendon.
Symptoms
Morning pain is a hallmark symptom because the Achilles tendon must tolerate a full range of movement including stretch immediately after getting up in the morning. Symptoms are typically localised to the tendon and the immediate surrounding area.
Swelling and pain are less common. The tendon can appear to have subtle changes in outline, becoming thicker in the A-P and M-L planes.
With people who have tendinopathy of the Achilles tendon that has a sensitive zone, combined with intra-tendinous swelling, that moves along with the tendon and of which sensitivity increases or decreases when the tendon is put under pressure, there will be a high predictive value that in this situation there is a case of tendinosis. The affected side of the tendon shows a larger diameter, higher stiffness, and lower strain in comparison to the non-affected side.
Causes
The precise cause of tendonitis remains unclear. Even though tendonitis of the Achilles tendon is often connected to sports activities, the ailment is also often found in people who do not practice sports. The biggest cause is the excessive overburdening of the tendon. A light degeneration of the Achilles tendon can be latently present, but the pain only appears when the tendon is overburdened. It is also noted that the ailment is usually not preceded by trauma
Diagnosis
Important for providing clues related to the mechanism of injury and history of the condition. Clinicians can use a subjective report of pain located 2 to 6 cm proximal to the Achilles tendon insertion that began gradually and pain on palpation to diagnose Achilles tendinopathy.
Objective examination: Important to fully assess the lower limb. Assessing the hip and knee will give clues to biomechanical contributions and muscle imbalances. In the foot and ankle we are looking for more local contributory and resulting factors:
Observation: looking for muscle atrophy, swelling, asymmetry, joint effusions, and erythema. Atrophy is an important clue to the duration of the tendinopathy and it is often present with chronic conditions. Swelling, asymmetry, and erythema in pathologic tendons are often observed in the examination. Joint effusions are uncommon with tendinopathy and suggest the possibility of intra-articular pathology.
Range of motion testing, strength, and flexibility: often limited on the side of the tendinopathy.
Palpation: tends to elicit well-localised tenderness that is similar in quality and location to the pain experienced during activity. Palpation often reveal palpable nodules and thickening.
Anatomic deformities: eg forefoot, heel varus, excessive pes planus, or foot pronation, should receive special attention. These anatomic deformities are often associated with this problem
A positive arc sign, and positive findings on the Royal London Hospital test.
Risks
There are some known risk factors related to the pathology of Achilles tendinopathy. few of these risk factors include:
Rapid changed to load
Prolonged steroid use
Family history of tendinopathy
Other factors include inappropriate footwear and the elderly population.