It’s not just athletes who suffer from a strained Achilles tendon, although tendonitis (or tendinitis) is one of the most common injuries in sports. From professional basketball players to recreational runners to waitresses, we have seen a trove of Achilles strains. Many people limp around for a week or more before deciding that this aching calf requires a visit to the clinic.
Unless you are very fortunate and the injury is minor, Achilles tendonitis requires professional diagnosis and treatment. Many cases can be treated conservatively with a boot or cast, by resting the injured leg and applying ice and physical therapy. But there are patients who wait too long and do too little, and it affects them for years afterward.
A strained Achilles usually presents as an ache or a burning pain (sometimes accompanied by swelling) in the back of the leg between the foot and the knee. It is possible to develop the condition just from walking. Weak muscles in the calf contribute to tendonitis, as do vascular (circulatory) problems, neuropathy (nerve damage) and rheumatic diseases.
The doctor will examine your leg and ankle, with special tests designed to diagnose Achilles tendonitis. If it turns out that you are one of the millions affected by this problem, treatment should commence immediately.
While weak muscles and overuse are primary causes of Achilles tendonitis, it has also been linked with the use of some pharmaceuticals. A class of antibiotics, Quinolones, has a strong association with the syndrome. (The popular drug, Cipro, is a member of the Quinolones family.) Also, prior use of oral steroids makes you more vulnerable.
If you start to feel symptoms in the back of your leg, it’s best to call the clinic closest to you in Sunnyvale, DeSoto or Dallas. A mild case of Achilles tendonitis will usually be curable. But if the injury has persisted for more than three weeks, it’s entered the chronic stage. This requires a different treatment approach.
Preventing Achilles Tendonitis
The way you walk may also predispose you to tendonitis. One factor is overpronation. When we place our foot on the ground while walking, the foot tends to roll a bit. Some people roll inward (overpronation); some roll outward (underpronation). If your tendency is to overpronate, it could be setting you up for an Achilles problem.
An orthotic device that fits into your shoe will help correct the gait. Another option is to wear a removable boot to immobilize the tendon while it heals. If the doctor recommends the boot, you may also need rehab after the boot is removed, because muscles atrophy when they’re not used for a while.
Before designing a treatment plan, we may order an MRI to assess whether the tendon is torn, or ruptured. While most patients recover with conservative treatment, some need surgery. We usually recommend surgery for patients whose work or avocation demands a return to full activity (professional athletes, for instance).
A study published in a Canadian medical journal showed that patients tend to recover equally well without surgery— as long as they engaged in a functional rehab program— but recovery took longer. Another issue is recurrence. Patients with damage to the Achilles tend to have subsequent incidents. Research shows that surgical intervention makes a second or third episode less likely.
We don’t recommend surgery for patients with diabetes, or those who’ve used oral steroids. Only your doctor can determine if you are a good candidate for surgery. If your Achilles problem has persisted for more than a few weeks, call one of our clinics in Dallas, DeSoto or Sunnyvale and ask for a consultation.
For more information about Achilles tendon repair, including surgery, see the website of the American Orthopaedic Foot and Ankle Society