What is Achilles tendonitis?
(Dr Geoff Davies, Western Mail 30th January 2012)
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Q My doctor says I have Achilles tendonitis. What exactly is it?
A Achilles tendinopathy is now known to be the result of a failed healing process following an injury, rather than an inflammatory condition. It presents with a painful, swollen Achilles tendon, an inch or two above the heel bone.
Q What causes Achilles tendonitis?
A It is thought that repetitive micro-trauma – small, usually unnoticed injuries caused by overuse – to the tendon produces the pain.
Many factors can make you susceptible to its development including overuse, over-training, change in footwear or training surfaces as well as bio-mechanical factors within the body, like foot arch problems or calf muscle tightness.
Q Do I need any special tests?
A Usually the diagnosis is made by a clinical examination, but in stubborn cases a diagnostic ultrasound scan can be performed by a radiologist or sports physician. This will confirm the diagnosis and exclude other potential issues, like partial tearing within the tendon.
Q Will I need an operation?
A Surgery is rarely needed. Specific exercises, including calf stretching and an eccentric strengthening programme is usually required – often supervised by a physiotherapist. A podiatrist may recommend arch supports to aid management. Usually symptoms settle over two to three months with appropriate treatment.
Q What if physiotherapy fails?
A There are a variety of second line treatments. These include extracorporeal shock wave treatment and autologous blood or platelet rich plasma injections, often under ultrasound guidance. These procedures help to speed up the body’s own repair mechanism. Steroid injections are generally best avoided as they may actually weaken the tendon.