What is the Achilles Tendon?
The Achilles tendon-the longest tendon in the body-runs down the back of the lower leg and connects the calf muscle to the heel bone. Also called the “heel cord,” the Achilles tendon facilitates walking by helping to raise the heel off the ground.
Achilles Tendonitis and Achilles Tendonosis
Two common disorders that occur in the heel cord are Achilles tendonitis and Achilles tendonosis.
Achilles tendonitis is an inflammation of the Achilles tendon. If treated this inflammation does not typically last very long. However, long standing pathology can lead to a degeneration of the tendon (tendonosis), in which the tendon loses its organized structure and is likely to develop microscopic tears. This degeneration can involve the site where the Achilles tendon attaches to the heel bone or just proximal to the insertion.
Symptoms Associated with Tendonitis or Tendonosis
- Pain-aching, stiffness, soreness, or tenderness which may occur anywhere along the tendon’s path. Often pain appears upon arising in the morning or after periods of rest, then improves somewhat with motion but later worsens with increased activity.
- When degeneration is present the tendon may become enlarged and may develop nodules in the area where the tissue is damaged.
Achilles tendonitis and tendonosis are usually caused by a sudden increase of a repetitive activity. Such activity puts too much stress on the tendon too quickly, leading to micro-injury of the tendon fibers. Due to this ongoing stress on the tendon, the body is unable to repair the injured tissue.
Athletes are at high risk for developing disorders of the Achilles tendon. It is also common in individuals whose work puts stress on their ankles and feet as well as in “weekend warriors”- those who are less conditioned and participate in athletics only on weekends or infrequently.
In addition, people with excessive pronation (flattening of the arch) have a tendency to develop Achilles tendonitis and tendonosis due to the greater demands placed on the tendon when walking. If these individuals wear shoes without adequate stability, their over-pronation could further aggravate the Achilles tendon.
In diagnosing Achilles tendonitis or tendonosis, the surgeon will examine the patient’s foot and ankle and evaluate the range of motion and condition of the tendon. The extent of the condition can be further assessed with x-rays, ultrasound or MRI.
Treatment approaches for Achilles tendonitis or tendonosis are selected on the basis of how long the injury has been present and the degree of damage to the tendon.
To prevent Achilles tendonitis or tendonosis from recurring after surgical or non-surgical treatment, the foot and ankle surgeon may recommend strengthening and stretching of the calf muscles through daily exercises.