The Achilles tendon connects the gastrosoleus muscle complex (calf muscle) to the foot via connecting at the back of the heel bone (calcaneus) at an area called the tendon insertion.Â The main purpose of this complex is to contract at the point when the entire foot is in full contact with the ground during walking or distance running.
|Conditions of the Achilles tendon
- Tendinitis- inflammation around and within the sheath (covering) of the tendon- can occur at the attachment of the tendon to the heel (insertional tendonitis), at the ‘cord’ (midsubstance tendonitis) or the muscle to tendon junction (myotendinous tendonitis)
- Tendinosis- inflammation and scarring and degeneration of the internal fibers of the tendon; a more serious condition
- Ruptures- these can be partial (portions of the tendon fibers), complete ruptures, and can occur slowly over a period of time (chronic, progressive), can occur suddenly from violent trauma (acute) or the tendon can slowly be degenerating and then tear completely (acute tear on chronic degradation)
- Biomechanical causes- since the muscle and tendon complex fire to stabilize the foot while it is in contact with the ground, any postural abnormalities of the foot (a pronated foot (low arch) or supinated/cavus foot (high arch)) create a higher demand for the muscle complex to fire harder every step a person takes- this puts eccentric (pulling) stress on the tendon and causes the fibers to gradually weaken
- Trauma- seen in direct impacts to the tendon, sports injuries, motor vehicle accidents or occupational injuries
- Disease processes- Systemic arthritis (Rheumatoid Arthritis)- cause weakening of the collagen fibers which degrades the tendon fibers
- Medicinal- a class of medications called fluoroquinolones (Cipro, Avalox, Levaquin) can weaken the tendon fibers while an individual may be using the medications for infections such as bronchitis or urinary tract infections
- Addressing any abnormal biomechanics is key. Use of proper supportive shoegear, prescription orthotics, proper stretching, and occasionally use of a resting/night splint are all important treatments. During the period of recovery, cross training and reduced high impact activity helps.
- Reducing the symptomatic inflammation- icing, physical therapy modalities such as ultrasound and ultrasound. It is against medical standard of care to inject the Achilles tendon with cortisone
If patients do not respond to conservative treatment, further diagnosis with MRI is warranted.
Surgical treatments include Radiofrequency microdebridement (Topaz), open surgical debridement, repair of any partial or complete tears and removal of any calcifications or spurring of the tendon to heel bone interface.