Inflammation of the Achilles tendon

introduction

With a length about ten centimeters and one diameter about a centimeterr the Achilles tendon is the strongest tendon in humans. she can Loads of more than 500 kg resist. The Achilles tendon, known in Latin as Tendo calcaneus is known, transmits the strength of the strongest flexor muscle in the upper ankle, Triceps surae muscle called on the heel. The triceps surae muscle is innervated by the so-called tibial nerve, which functions with the Achilles tendon reflex can be examined. Various causes can lead to one acute or chronic inflammation lead this strong tendon. The most common mechanical causes can be identified, which have their origin in an overload or an improper strain on the muscles.

Symptoms

The Leading symptom an inflammation of the Achilles tendon strong pain. These pains can be sharp in nature. In the case of so-called acute inflammation of the Achilles tendon or acute inflammation of the tendon sheaths that surround the tendon, in particular severe, often stabbing pain during exercise in the area between the calf muscles and the heel. Often the pain can be identified at the tendon attachment of the heel. This pain can often be triggered and localized by pressure or passive movement. Very often there is one accompanying the pain swelling to recognize. In contrast to acute inflammation, which usually only causes pain during exercise, chronic inflammation leads to a typical one Starting painwhich is particularly noticeable after lying down or sitting for a long time or after getting up in the morning. The pain often increases when walking uphill. Additional symptoms are pain on pressure and hardening of the Achilles tendon. When feeling with your hands, you can on the one hand trigger pain in the area of ​​the tendon and on the other hand feel a hardening or thickening of the tendon itself. These hardenings can lead to an audible crunch when moving.

Appointment with an expert in Achilles tendonitis?

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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.

You can find me in:

• Lumedis - your orthopedic surgeon
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  60311 Frankfurt am Main

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Further information about myself can be found at Dr. Nicolas Gumpert

root cause

Various causes can lead to acute or chronic inflammation of the strong Achilles tendon. The most common mechanical causes can be identified, which have their origin in an overload or an incorrect load on the muscles. This happens especially during sport. Fast running and uphill running put a special strain on the Achilles tendon, which has to bear the weight of the entire body while walking. In addition, an inappropriately increased exercise intensity and too much exercise in general lead to a strong overexertion of the Achilles tendon. Such overload is exacerbated by being overweight, which naturally increases the burden on the Achilles tendon. Not only incorrect training, but also incorrect footwear or running on poor ground can cause stress on the Achilles tendon and thus inflammation. The body's own factors also play a major role in the list of causes. Tension and shortening of the calf muscles or leg length differences lead to improper strain on the muscles and tendons, so that the Achilles tendon can be strained on one side. An anatomical change in the heel, such as is the case with a so-called over-leg, can also lead to considerable incorrect loading and thus damage to the Achilles tendon. Other causes can be previous injuries to the ankle joint, muscles or the Achilles tendon itself.

Inflammation of the Achilles tendon attachment is often associated with bursitis and heel spurs. Such a spur, which arises between the bone of the heel and the Achilles tendon, irritates the Achilles tendon considerably and can lead to a chronic inflammation of the latter. In addition, various rheumatic diseases can cause Achilles tendinitis. Rheumatoid arthritis, which is a chronic inflammatory system disease due to an autoimmune reaction of the body, can lead to involvement of the Achilles tendon. In particular with Bechterew's disease there is a painful inflammation of the tendon attachment of the Achilles tendon, too Enthesopathy called, known. This mostly affects women between the ages of 20 and 40. In addition, there is a high familial accumulation of this disease.

Another cause of Achilles tendonitis can be the use of certain antibiotics. Please also read our article on this: Achilles tendonitis caused by antibiotics

therapy

The therapy for inflammation of the Achilles tendon depends on the cause of the inflammation and whether it is an acute or chronic process.

In the case of acute inflammation of the Achilles tendon, it has proven useful to cool the affected area, put your foot up and stop the load. It is also advisable to reduce the intensity of the exercise that is responsible for the pain or to take a complete break for a while. It is possible to switch to another endurance sport such as swimming until the pain has subsided. It is also possible to treat the pain with medication. Well-known pain medication such as ibuprofen, diclofenac and paracetamol are available for treatment. Ibuprofen and diclofenac belong to the group of so-called non-steroidal anti-inflammatory drugs, which not only relieve pain, but also have an anti-inflammatory effect. These drugs can not only be taken in tablet form, but also applied locally as an ointment. Another possibility of pain treatment is the injection of a local anesthetic by a doctor in the area of ​​the tendon. The application of heat by means of a heat pad about one day after the start of an acute inflammation of the Achilles tendon has also proven itself. Electrotherapy, including iontophoresis and ultrasound therapy, has also found its place in the treatment of Achilles tendonitis. In the acute phase, it is also helpful to raise the heel and soft bedding of the affected foot in the shoe. Finally, another option is to do stretching exercises on the affected side. Therapy for chronic inflammation of the Achilles marriage differs from acute therapy.

In the case of chronic inflammation, the main focus of treatment is physiotherapy and orthopedic therapy. As in the treatment of acute inflammation, heel heels with insoles as well as massage and stretching exercises are helpful.

For a long-term treatment of Achilles tendonitis, bandages are recommended, which above all ensure stability in the foot. A distinction is made between bandages with different focuses, which should be weighed individually and lead to a relief of the Achilles tendon.

For further information, we recommend our website: Bandage for achilles tendonitis

If the cause of a chronic inflammation of the Achilles tendon is a heel spur, this can either be surgically or through so-called extracorporeal shock wave therapy (ESWT) be eliminated. The doctor applies pressure waves to the affected area in several sessions. If the inflammation cannot be cured with conservative methods such as medication, physiotherapy, insoles and raised heels, or if the inflammation is too extensive, surgery can be performed as a last option. During such an operation, the inflamed part of the Achilles tendon is removed. Often a new piece of tendon produced by the body is inserted into the operated area. After such an operation, extensive follow-up care, consisting of physiotherapy and gradual increase in load, is necessary. Running is therefore only allowed after several weeks. If ankylosing spondylitis is a possible cause of chronic Achilles tendonitis, rheumatological treatment is often necessary in addition to physiotherapy, gymnastics and orthopedic treatment. Non-steroidal anti-inflammatory drugs such as ibuprofen or diclofenac, corticosteroids or special anti-rheumatic drugs such as sulfasalazine or so-called biologicals are used as drugs.

diagnosis

When diagnosing inflammation of the Achilles tendon, the anamnesis and the clinical examination. In addition, the doctor has various radiological examinations such as the Ultrasonic, the roentgen or the Magnetic resonance imaging available that can confirm the suspected diagnosis of inflammation of the Achilles tendon.

When taking the medical history, it is important to find out where, how and since when the Pain exist and in what situations the pain occur. It is also important to find out what kind of sport and what other physical activities the patient does. It is also helpful to find out whether, for example, previous rheumatic diseases or Metabolic diseases such as gout or diabetes mellitus.

During the physical examination, one should first pay attention to whether Misalignments such as bow or knot legs, Leg length differences or Muscle shortening can be recognized and can adequately explain the complaints. When palpating the Achilles tendon, pressure pain is typically triggered above the heel bone if the tendon is inflamed. Will the foot actively and passively moved, then an inflammation of the Achilles tendon can also trigger pain. In addition, a Achilles tendon thickening or Nodules in the tendon area Keys. If further diagnostics are planned, an ultrasound of the Achilles tendon is the first option. In this investigation that on Ultrasonic waves based and also Sonography the doctor may call in case of inflammation of the Achilles tendon Condensations, Calcifications, Partial cracks or even in the worst case Cracks detect. If a heel spur or another bony cause for an Achilles tendonitis is suspected, this question can be investigated with the help of an X-ray examination. Heel spurs can usually be seen clearly on an X-ray.

The final radiological procedure is a MRI of the Achilles tendon prepared. With this examination method, even small changes in the Achilles tendon can be diagnosed with certainty. The disadvantage of the method is that Cost and duration of the investigation to mention. Finally, certain underlying diseases can be identified or excluded by means of laboratory tests. In particular Metabolic diseases how Diabetes mellitus or gout or rheumatological diseases such as rheumatoid arthritis or ankylosing spondylitis can be recognized if they are the cause of inflammation of the Achilles tendon. In particular, the inflammation levels like that C-reactive protein or the Sedimentation rate and specific antibodies are to be named and checked for rheumatological diseases.

forecast

The prognosis depends, among other things, on the Underlying disease and the Cause of the disease (Heel spur, ankylosing spondylitis, diabetes), whether it is an acute or chronic inflammation and the age of the patient. In principle, however, Achilles tendon complaints require conservative and surgical therapy always an immobilization. Such immobilization is usually done with a leg brace, depending on the severity of the disease about four to eight weeks remains. Gradually increasing the load is recommended during immobilization. Alternative sports like swimming or cycling can be done during this time.

prophylaxis

One of the key to the good function of the Achilles tendon is strong and well-functioning Calf muscles. Here is especially the Triceps surae muscle to be mentioned, which attaches to the heel via the Achilles tendon. If possible, the prophylaxis daily strengthening exercises of the calf muscles are performed.

There are various exercises that are suitable for strengthening the calf muscles. A possible exercise to strengthen the muscles and the Achilles tendon can look like this: The test person stands on the edge of a step and stands for two seconds on his Tiptoe and then lower your heels below the step. The exercise is about 15 times repeated and carried out 15 times after a half-minute break. After a few weeks, the calf muscles and the Achilles tendon are strengthened. This is also suitable Exercise can also be used to reduce pain associated with Achilles tendonitisif this was not caused by overload. In the first two weeks, the exercise can certainly lead to increased pain and sore muscles. It should also be noted that the Upper body held straight will and the Knees slightly bent are.

In addition to these exercises, there are a few aids that can help prevent inflammation of the Achilles tendon. An increase in the heel or insoles are a possibility. In addition, when choosing the Running shoes not be saved and a suitable model to get voted. The running shoe should not be too hard and rather have a cushioning effect so that less forces act on the tendons of the legs. From High heels or flip flops are not recommended in any casebecause they put a lot of strain on the Achilles tendon. Since overstraining while running or jogging is a common reason for inflammation of the Achilles tendon, it is important to ensure optimal training intensity and an analysis of the gait and running pattern can help to prevent inflammation of the Achilles tendon. In addition, regular warming up and stretching can prevent inflammation of the Achilles tendon.