by Alan Jordan
Tendons are simply what connect muscles to bones. They transfer the force generated by muscles to bones and hence result in coordinated movement in joints. The Achilles tendon is the largest tendon in our body and it withstands tensile forces of up to 8 times body weight during running.
The term tendonitis is no longer used when referring to pathology of the Achilles tendon as it is now believed that there is no inflammatory changes and it is more a degenerative progression of the structure formed by spirally aligned proteins called collagen.
Onset and causes
Achilles tendinopathy may initially present itself with discomfort in the morning or at the start of physical activity, but then subsiding shortly thereafter. The progression of the problem is when pain persists through activity and also after. Initially there might be no visible changes but chronic presentation shows a nodule in the middle third of the tendon. There may also be redness. This is the most common area of problems in the tendon, and it is usually exquisitely painful on palpation. Less common is pain where the tendon inserts in the bone called Enthesitis and this is more of an inflammatory pathology. It is important to distinguish between the two and management may vary.
Tendon problems may arise from overuse, inappropriate footwear, running or training on a slope/incline, poor foot biomechanics and a sudden increase/change of your training program. Giving these causes, it may sound that only athletic people could have Achilles problems. Many people present in our clinics with Achilles problems even though they lead a sedentary lifestyle. The initial irritation may be something as innocuous as fast walking during your commute into work wearing high heels or hard-heel office shoes and also keeping your foot in an awkward position while sitting at work. Predisposing condition such as diabetes, being overweight, inflammatory joint disease may also lead to this problem.
The earlier the diagnosis is made and addressed, the better the outcome of treating Achilles teninopathy. Initially, conservative treatment such as rest, correction of obvious incorrect training and footwear, analgesia, ice and gentle mobilisation. A proven protocol is that of eccentric exercise, which involved active lengthening of the muscle-tendon complex. It is very important that the patient adheres to this program while receiving treatment. It is very important to analyze the walking and running gait and corrective orthotics may be prescribed in the case of any faults. If symptoms persist, shockwave therapy and platelet rich plasma injection and surgical intervention are options that would be considered.