The Achilles tendon is a tendon at the back of the leg that attaches the calf muscles (gastrocnemius, soleus, and plantaris) to the heel bone (calcaneus), and is considered to be the thickest tendon in the body. It is responsible for plantar flexion of the foot (pointing or pushing off from the toes), and flexion of the knee, which are especially important for walking. Tendinitis refers to inflammation of a muscle, which is most often due to repetitive motions or overuse. Other causes may include a sudden increase in activity, tight calf muscles, or bone spurs (extra bone growth) present where the tendon attaches to the heel bone. Pain and swelling are common symptoms of inflammation, which typically occur at the heel or along the tendon. The tendon may also be visibly red and warm to the touch, and it may be difficult to point or push off from your toes when standing. In addition, people that suffer from Achilles tendinitis will typically experience thickening of the tendon, stiffness in the morning, have an increase in pain following activity or exercise, and limited range of motion of the foot.
There are two types of Achilles tendonitis: Non-insertional Achilles tendinitis and insertional Achilles tendinitis. The non-insertional type affects the muscle fibers of the middle portion of the tendon, while the insertional type affects the muscle fibers that attach to the lower portion of the heel.
In terms of treatment, the concept of “RICE” as discussed in previous columns, applies to this type of injury. Rest, Ice, Compression, and Elevation of the Achilles tendon can be useful to relieve inflammation and pain. Physiotherapy treatment may also be beneficial in order to improve range of motion, strength, and further reduce pain and inflammation. Your physiotherapist may prescribe exercises designed to stretch the calf muscles and improve strength. Research has shown that performing specific eccentric exercises (strengthening while lengthening the muscle) is effective in the treatment of Achilles tendinitis. In addition, orthotics and supportive footwear often help to relieve pain by correcting poor foot mechanics. Please consult with your health care provider to determine which treatment options would be appropriate for you.
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