Achilles tendonitis
Synonyms
Inflammation of the Achilles tendon, tendonitis of the Achilles tendon, tendopathy of the Achilles tendon
Definition of Achilles tendonitis
Achilles tendonitis is a common cause of pain in and above the heel. This usually results from a pathological change or minor injury to the Achilles tendon as a result of
- Overloads or
- physical changes such as muscle shortening.
- Inflammation in the classic sense is rarely the cause of the symptoms.
The Achilles tendonitis leads to
- Pain and
- Swelling in the affected area,
usually 2 - 6 centimeters further above the insertion of the Achilles tendon on the heel bone, as well as restricted mobility and reduced athletic performance.
Achilles tendinitis can be differentiated from achillodynia, which is a pain syndrome in the area of the Achilles tendon that is usually not associated with inflammation and occurs particularly during vigorous physical activity.
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Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
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Athletes (joggers, soccer players, etc.) are particularly often affected by the Achilles tendonitis disease. In many cases, the cause of the Achilles tendonitis cannot be identified at first. Therefore, the treatment requires a lot of experience. I focus on Achilles tendonitis.
The aim of every treatment is treatment without surgery with a complete recovery of performance.
Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.
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Further information about myself can be found at Dr. Nicolas Gumpert
On the term Achilles tendonitis
Current research shows that the Achilles tendinitis is not inflammation in the classic sense. That is why in recent years this clinical picture has become established as Achilles tendon tendopathy to call. This is justified by the fact that no inflammatory foci or inflammatory cells were found during the examination (e.g. Leukocytes), but only destroyed (degenerate) Fabric with an irregular structure.
The origin (etiology)
Achilles tendonitis can be either
- acute or
- be chronic.
In acute Achilles tendonitis, the symptoms appear for a few days, usually as a result of increased training.
With chronic Achilles tendonitis, the symptoms appear over a longer period of time and are usually independent of short-term stress.
In addition to this classification, you can also determine the location of the pain that occurs. Most pain occurs either at the point of attachment on the heel (Heel bone, calcaneus) or in the middle part of the Achilles tendon, about 4 cm above the point of attachment. Because of the poor blood supply, such injuries are slow to heal.
Gyrase inhibitors / ciprofloxacin / ofloxacin as the cause of Achilles tendinitis
Gyrase inhibitors, which also include the drug ciprofloxacin, are antibiotics that intervene in the DNA metabolism of bacteria and can thus fight them. In the early 1990s, it became known with some drugs in this group of drugs that undesirable side effects, including Achilles tendonitis, occurred more frequently when taking these drugs.
Some studies that dealt with the topic came to the conclusion that these side effects can actually be linked to some agents from the group of gyrase inhibitors. A representative study from the Netherlands was able to establish a correlation between Achilles tendonitis and the drug ofloxacin, whereas the side effects of other gyrase inhibitors such as ciprofloxacin or other antibiotics were less common.
In summary, one should always think of a side effect of a gyrase inhibitor (especially ofloxacin or ciprofloxacin) in the case of unclear and particularly bilateral inflammation of the Achilles tendon.
Epidemiology
Achilles tendonitis occurs particularly often in people who do more sport or are even competitive athletes. In this context, runners in particular suffer
- Around 9% of all competitive athletes suffer from Achilles tendonitis.
- In the general population, 1 in 10,000 (1/10000) has this condition.
Symptoms
In general, the symptoms first appear at the beginning or the end of training or sporting activity, during which the patients often feel pain relief. With further exertion, the pain continues to increase until it is impossible to move painlessly or to do sports. A distinction is also made between acute and chronic Achilles tendinitis when it comes to symptoms.
Acute Achilles tendonitis leads to gradually increasing pain in the Achilles tendon just above the heel.This process usually takes a few days and the pain gets worse. The pain can be temporarily relieved by resting. When examining the Achilles tendon manually, you can see that it has hardened as a sign of acute Achilles tendonitis.
Chronic Achilles tendonitis often follows acute Achilles tendonitis. In chronic inflammation of the Achilles tendon, the pain occurs for weeks or months. The pain remains about the same with any kind of exercise or sporting activity, but is particularly severe when walking uphill or climbing stairs.
After rest breaks or in the morning, the pain is particularly severe because the Achilles tendon is then slightly stiffened and is not elastic enough when the load is repeated to be able to perform the movements painlessly. Sometimes small nodules can be found during the palpation examination, especially at a distance of 2-4 cm from the insertion of the Achilles tendon on the heel bone. The Achilles tendon is often swollen and thickened and you can see a slight reddening of the skin above the Achilles tendon. You can rarely hear a slight crack when you press the Achilles tendon with your finger and move your ankle at the same time.
Not all criteria have to be met to be able to speak of an Achilles tendonitis. For example, reddening of the skin is rare.
Duration of achilles tendonitis
The duration of achilles tendonitis depends on the severity of the disease. There are also basically two different types, acute and chronic Achilles tendinitis. The acute inflammation that has occurred suddenly can be healed after one to two weeks if you take rest and possibly other measures such as physiotherapy. If the inflammation has become severe or chronic, lengthy conservative therapy or surgery is often necessary. After this, the affected leg is immobilized in a splint for one to two months, followed by a rehabilitation phase of around three months. During this time, the tendon must be spared and must not be exposed to high loads.
Read more about: Duration of achilles tendonitis
Causes of Achilles tendonitis
Achilles tendonitis is an overuse injury. It often occurs when the load is increased significantly over a short period of time and the Achilles tendon is exposed to an unknown level of stress. This disease is particularly common in running and results from an overload caused by
- too many training kilometers,
- running speed too fast or
- particularly hilly terrain are favored.
When walking uphill, the Achilles tendon is also strongly stretched with every step, which does not cause any problems for a certain time, but the Achilles tendon can tire more quickly in the future due to the additional stress. In addition to the terrain, the training surface is also a possible cause of Achilles tendonitis.
If you switch from forest paths to asphalt, for example, you may experience more complaints afterwards. In addition to increased exercise activity, shortening the breaks in between can also lead to increased pain. In addition to the training conditions, footwear should not be neglected as a possible cause of Achilles tendon injuries. Especially if women wear very long shoes with high heels, the Achilles tendon can shorten, as the Achilles tendon is compressed by the shoes with high heels. When switching to normal shoes, problems often arise because the Achilles tendon is overstretched to ensure normal walking. Age also plays a role in the development of Achilles tendonitis. People aged 35 and over are particularly susceptible. Adolescents and young adults, on the other hand, very seldom have problems with it, even with high levels of stress.
Anatomically speaking, calf muscles that are too weak or too short (Gastrocnemius and Soleus) and an ankle with restricted mobility can lead to Achilles tendon complaints.
A misalignment of the foot as a result of a clubfoot or an equinus foot can also lead to Achilles tendon problems. However, these deformities are often treated conservatively immediately after birth and are usually without consequential damage.
Achilles tendonitis from jogging
Achilles tendonitis is a very typical disease of competitive athletes, and especially runners. People who like to go jogging for a long time are particularly often affected by Achilles tendonitis. Therefore, especially these risk groups should pay close attention to pain in the Achilles tendon and calf area and, if necessary, take care of the area in order to prevent the condition from worsening.
Jogging is therefore a risk factor for developing Achilles tendonitis, as in this sport extreme loads are mainly directed via the Achilles tendon and only then spread over the body. With every step, the load when jogging is a multiple of your body weight. It is therefore hardly surprising that a very large proportion of competitive athletes develop Achilles tendonitis at least once in their career.
Achilles tendonitis caused by buckled feet
The buckle foot (Pes valgus) describes a pathological misalignment of the foot. The inner (medial) edge of the foot is lowered, while the outer (lateral) edge of the foot is raised. The buckling foot often comes up in connection with a flat or flat foot and with knock knees.
From a medical point of view, the articulated foot is a problem, especially with high loads such as those often encountered in sports. The unnatural position of the foot significantly increases the loads on the Achilles tendon compared to a healthy foot position. Especially in connection with flat feet, the mechanical forces on the Achilles tendon increase because the natural roll function is no longer available.
You can find a lot more information on our website: Causes of Achilles tendonitis
Therapy of achilles tendinitis
Achilles tendonitis medication
If achilles tendonitis occurs, drug therapy can be helpful. Taking anti-inflammatory painkillers such as ibuprofen and diclofenac can on the one hand relieve the discomfort as the pain subsides, and on the other hand these drugs inhibit the inflammation in the tissue.
When taking this medication, it is important that the pain relief does not lead to overuse of the Achilles tendon, as the pain is no longer perceived as a warning signal. Ointments containing these active ingredients can be applied superficially, but usually do not work as strongly as tablets. Although ibuprofen and diclofenac are freely available in pharmacies, it should be noted that long-term use can lead to side effects, so that these drugs cannot be taken permanently without consulting a doctor.
Therapy with herbal active ingredients can also be carried out. For superficial application, arnica, horse ointment or tea tree oil, for example, are used. But homeopathic injections can also be carried out in the area around the Achilles tendonitis.
While the use of cortisone is very effective and widespread for many inflammations of the body, cortisone should not be injected into the affected tendon in the case of Achilles tendinitis, as this can make the tendon more brittle and more prone to tears (Achilles tendon rupture).
Taping for achilles tendonitis
The use of kinesio tape can be particularly helpful for mild Achilles tendinitis and relieve the patient of his symptoms. A kinesio tape is a four to five centimeter wide tissue tape that is stuck to the skin when there are problems with the musculoskeletal system. The mode of action should be based on the activation of sensory receptors in the skin and the activation of the connective tissue through the mechanical stimulation of the tape. While there is no scientific evidence that kinesio tapes work, this method is widely used and made popular in society by taped athletes who can be seen on television at major sporting events.
Application:
Although it is advisable to leave the taping to a professional, in principle it is also possible to use the kinesiotape yourself. There are various tape techniques available for treating Achilles tendonitis. As an example, two fairly straightforward methods are described below. When taping, it is important that the corners of the kinesio tape are rounded off with scissors, as this will keep it on the skin longer.
1. First, a strip of tape is affixed from the underside of the heel over the Achilles tendon along the calf to just below the hollow of the knee. It is important that the kinesiotape is not pulled under tension, but stuck to the skin in a relaxed state. Another strip of tape, which is a little shorter, is cut lengthways to create a Y-shape. The base of the Ypsilon is glued to the Achilles tendon, the two wings should be glued to the left and right of the calf muscles. Finally, a strip of tape is stuck around the ankle, the tension of the tape should not be too great here either.
2. Similar to the method described first, a strip of tape is stuck from the underside of the heel over the Achilles tendon to the calf. It should reach about mid-calf. Now two strips of tape of similar length are affixed from the outside of the heel to the inside of the calf (also here approximately to the level of the middle of the calf) and vice versa.
The kinesio tape can stay on the skin until it comes off by itself. It can easily be showered with it.
Read more on the topic: Taping for achilles tendonitis
surgery
Surgery for Achilles tendonitis should be carefully considered.
It is recommended to first conduct treatment with conservative measures. Although long-term inflammation can tear the Achilles tendon, these should be exploited. If the symptoms persist afterwards, an operation should be considered.
Procedure of the operation:
In principle it is possible to have the operation outpatient In the case of inpatient treatment, the hospital stay is usually one to two days.
The Achilles tendon surgery is performed either in local anesthesia or in general anesthetic and usually takes about half an hour.
The operation of the Achilles tendon can usually minimally invasive carried out so that only a small incision is necessary. The aim of the surgery is to find tissue thickened and inflamed Bursa to remove. Ossifications on the Achilles tendon are milled off.
If the inflammation is very advanced, it may be necessary to make a larger skin incision to see the entire length of the tendon. This is necessary because any dead tissue must be removed.
The affected person comes after the operation Lower leg in a special splint for a few weeks so that the tissue can recover and heal. It is important that the functionality of the Achilles tendon after surgery through appropriate rehabilitation measures such as physical therapy is restored. The load on the inflamed tendon should be gradually increased; in the first three months after the operation, there should be no major sporting activity.
Exercise for Achilles tendonitis
Achilles tendonitis often occurs exercise noticeable. Especially under Runners this disease is common.
She's going through pulling pains Noticeable in the affected Achilles tendon, it can also happen that the affected tendon overheated or swollen is. The pain usually occurs at the beginning of the exercise and gets better during exercise. However, the pain can only appear after the exercise at rest. If such symptoms occur, exercise should be stopped to allow the inflammation to heal and not worsen.
If you continue to exercise with an existing Achilles tendonitis, the symptoms can become chronic and treatment is much more difficult and protracted.
In this context, it is also important that the athlete is sensitized after an inflammation has occurred and before his training sessions carefully warmed up, as this can prevent a new Achilles tendonitis. Also regular stretching of the calf muscles is important because shortened calf muscles put additional strain on the Achilles tendon.
If the Achilles tendonitis has healed after treatment, the tendon should continue to be spared for some time and not exposed to high loads. Running sports and activities that exert a great deal of force on the Achilles tendon should not be performed during this time. Less stressful sports such as cycling are definitely possible.
What are the prospects?
If an Achilles tendonitis occurs for the first time and is treated quickly, the injury usually heals without any consequential damage. It is particularly important to allow sufficient time for the Achilles tendon to heal before putting full strain on it again, otherwise you run the risk of chronic Achilles tendonitis. If patients ignore the first signs of Achilles tendonitis or do not allow enough time to heal, the inflammation can become chronic and very difficult to treat.
Unfortunately, it is not possible to specify how long an Achilles tendonitis takes to heal.
Achilles tendon anatomy
The Achilles tendon connects the heel (Calcaneus) with the calf muscles (Gastrocnemius muscle and Soleus muscle), more precisely with their aponeuroses. The Achilles tendon is the strongest and thickest tendon in the human body and can withstand forces of up to 12 times the body weight. It stabilizes the foot on the leg and particularly initiates the push-off movement when running and running.
Illustration of achilles tendinitis
Achilles tendinitis
is an overload violation
- Achilles tendon -
Tendo calcaneus - Heel bone -
Calcaneus - Three-headed calf muscle -
Triceps surae muscle
consisting of:
- Internal calf muscle -
Gastrocnemius muscle,
Caput mediale
- External calf muscle -
Musculu gastrocnemius,
Caput laterale
- clod muscle -
Soleus muscle
Typical causes of a
Achilles tendonitis
(see pictures):
- running (too many training kilometers,
running speed too fast)
- Running uphill
(hilly terrain), climbing stairs
- Footwear (high heels)
Here you get to: Illustration of achilles tendinitis
You can find an overview of all Dr-Gumpert images at: medical illustrations
Injury histology
When viewed under a microscope, the injured Achilles tendon has advanced degenerations and changes in the arrangement of collagen fibers. These microscopic changes are called Tendinosis. Sometimes, however, these microscopic changes can also be found if there are no symptoms at all.
The microscopic lesions are particularly often found 2-6 centimeters away from the attachment point of the Achilles tendon on the heel, as this area is particularly poorly supplied with blood. However, current research shows that tendinosis, i.e. degeneration of the Achilles tendon in this area, leads to the sprouting of new blood vessels and nerves. The sprouting nerves lead to the pain, but the blood vessels lead to faster healing of the injury.
