Tendonitis is a term used for several similar conditions and all are basically overuse injuries of the tendon and its related structures. These associated conditions may be termed peritendinitis, peritendinitis with tendinosis, tendinosis, partial tendon rupture, or total rupture.
The symptoms of Achilles tendonitis are usually pain and discomfort around the tendon in the back of the heel. There may be some swelling, or thickening of the tendon and its structures. In more severe cases a popping sensation or sound may appear when the ankle is moved through its range of motion. Tendonitis usually appears worse over time, whereas a rupture is more often from a single traumatic event.
The cause of achilles tendonitis is from repetitive trauma to the Achilles tendon. This can occur from a sudden increase in activity or intensity, inadequate muscle recovery time between activities, returning to activities after a prolonged period of inactivity, repetitive hill running, or running on uneven or slippery terrain. Rigid soled shoes can also be the causative factor. Your foot structure when combined with the repetitive stresses can trigger this condition.
Diagnosis is made mostly by clinical examination. Sometimes x-rays or an mri can be helpful in determining the extent of pathology or ruling out a fracture or partial rupture.
Podiatric Care usually involves a biomechanical examination of your foot. Excessive pronation has been shown to be an important factor for achilles tendonitis and ruptures. Orthotics can be used to shorten the time of pronation during the gait cycle for the treatment of tendonitis. These supports may be more important for treatment after tendonitis has subsided for the prevention of re-injury. The immediate treatment for inflammation is usually through use of anti-inflammatory medications, rest, and ice. Total rest is usually not required, but a decrease in activity or modification of the activity is required. Stretching exercises can be helpful, as well as a mild heel lift in the shoe. More severe cases can be placed in a cast for total immobilization usually not longer than a couple weeks unless there is a rupture. Some physicians use injections of a steriod along the tendon, but not directly into the tendon as this can weaken it further.
Surgery can be used in severe cases where the conservative measures have failed after a period of time, usually 4-6 months. Usually the area of pain or defect is identified and incisions are made in the paratenon. If a large defect is found, sometimes a tendon graft will be used for the repair. Post-operatively, the period of immobilization will depend on the size of the defect that was repaired and how it was done. Usually the immobilization is between 2-6 weeks.