Achilles Tendonitis

The Achilles tendon is the combination of the gastrocnemius and soleus muscles as they course down the leg and attach to the calcaneus. This large tendon is a powerful plantar flexor of the foot. The tendon is under a resting tension, ready to propel the foot forward when the brain sends it a signal. It is this resting tension that may become problematic. For example, part or a flatfoot condition involves the heel cord contracting, a condition we call "equinus." If the resting tension is excessive, even small escalations of use may cause pain to develop, a signal that the tendon is being overworked. When tension exceeds the elasticity of the tendon small tears may develop. Small tears can scar in, but this tissue is weaker than the original tendon fibers. consequently a cycle can develop of micro tearing and repairing. Eventually, enough of the tendon is compromised and a nodule or lump may appear in the tendon. This is an indication that things have degenerated quite a bit. Stretching and warming up the tendon before activity is the mainstay of prevention and treatment of early Achilles tendonitis. This is performed with bands, towels, or just gravity, to eccentrically load the tendon and get it ready for engagement. Unfortunately, tendonopathy (as it is more appropriately termed) is not a quick fix; it involves weeks and sometimes months to work through before returning to normal activity.  When stretching and resting do not alleviate the pain and tightness of the Achilles tendon we may resort to surgical methods. This can vary from high energy sound waves directed at the tendon, radiofrequency ablation of the scarred tissue, up to open debridement, tendon lengthening and even tendon transfers.  It is helpful to know that 80% or more patients will not escalate to this level. The vast majority will respond well to appropriate treatment and addressing underlying biomechanical issues.  The content of this podcast is for educational and informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.