Achilles Tendinitis

Achilles tendinopathy is a general term used to describe the combination of pain, swelling and a decrease in performance surrounding the Achilles tendon. Achilles tendinitis is an acute inflammatory condition of the tendon itself which through histological examination shoes evidence of an infiltration of inflammatory cells. 

In general, activities that involve running and jumping pose a great risk, with recents estimates of just over 6% of all running injuries involving the Achilles tendon. Those aged 35 years and over are at an increased risk for developing disorders of the Achilles tendon.

Causes:

During the normal gait cycle the Achilles tendon is subjected to substantial loads and may reach up to 12.5 times body weight during running. The magnitude of these loads and the repetitive stress placed on the tendon during regular location are what makes the Achilles tendon susceptible to overused injuries and ruptures. Structural abnormalities may alter the way in which the gait cycle is performed, thereby increasing the mechanical load place on the Achilles tendon during locomotion and increasing the risk of mechanical injury.

Often times a forefoot varus deformity which is when the plantar forefoot locks in an inverted position relative to the plantar rear foot. This structural malalignment cause prolonged subtalar joint pronation which in turn produces a whipping action or bowstring effect on the Achilles tendon as the calcaneus remains in an excessively everted position. This snapping of the tendon may lead to micro tears along the medial aspect of the tendon.

Treatment:

There are a number of conservative treatment option available and new concepts and modalities. The most agree upon first course of action is rest of modified activity (swimming, biking) to take pressure and weight off foot as much as possible. Ice to decrease the swelling. 

The use of custom foot orthoses is frequently used for the treatment of Achilles tendinopathy when there is a structural or mechanical deficit detected during the clinical examination. Foot orthotics help address the biomechanical abnormalities such as excessive pronation as the therapeutic effect. In addition to foot orthoses, often times a heel lift shall be placed into the orthotic in an effort to raise the affected heel and reduce the tension on the Achilles tendon.