Achillotenositis – Inflammation, irritation and swelling of the Achilles Heel

Under the term Achillotenositis are grouped different diseases that can affect the Achilles heel. The most frequent are insertional tendonitis, tenosynovitis (injury of the fluid-filled sheath) and tendonosis (tendonitis of the tendon’ body). Treatment patterns for each case do not differ substantially, and its application will depend basically upon the condition of the patient.

SYMPTOMS

• Pain when exerting effort. Although the pain is only noticeable when doing certain importance efforts such as weight lifting, jumping or sprinting, when the inflammation reaches a certain level the sportsperson can feel pain even when walking.

• When the tendon is pressed by the thumb and fore fingers, an acute pain appears when palpating it. This pain can extend itself towards zones of the tendon not receiving direct pressure.

CAUSES

“ Those affected by achillotenositis usually experience pain when doing an effort or when palpating their tendon „

1. Changes in the training routines:

• Increases in the training intensity without proper preparation.

• Changes in the contact surface (irregular, hard surfaces)

• Changes in the training technique that can give way to a deterioration of the optimal functionality of footstrikes.

2. Use of inadequate shoes for a specific sporting practice. It is very frequent among inexperienced or careless sportspersons to use the same shoes to practice several different sports.

3. Structural changes in the foot (varus, valgus feet) and shortening of the triceps surae muscle.

Once the most acute phase has passed (that can last for several days depending on the seriousness of the injury) treatment can begin. This consists in applying massage every four or five days, both on the muscular bundle (in order to reduce muscular tone, thus reducing tension over the tendon) as well as on the tendon itself. With the same objective daily stretching exercises are also carried out. The exercises alternate 30 seconds of stretching with 60 seconds of rest. This process is repeated from three to five times daily, depending on the patient’s reaction. We advise sportspersons to visit a chiropodist who will examine the foot structure and footstrikes in order to study the possible use of corrective insoles. Finally, and only if the doctor authorizes it, the muscular strengthening phase is begun by performing specific gastrocnemius and soleus muscle exercises in order to recover physical fitness and to renew sport practice at optimal levels. At the beginning, the exercises can be done only with the injured leg so that we can insure correct exercise practise.

EXERCISES

Heel elevation while sitting. This exercise works specifically the soleus. Since we keep the knee flexed, the gastrocnemius becomes shortened in a passive way, thus losing almost all its contraction potential.

Heel elevation while standing. This exercise works the triceps surae in its entirety. It is recommended to do so while slightly flexing the knee to alleviate tension in the posterior side.

WORKING GUIDELINES

Start carrying out exercises following the guidelines detailed below:

• Frequency: 3 weekly sessions, during alternating days.

• Intensity: about 40% of the level prior to suffering the injury.

• Series: 4 sets of every exercise.

• Repetitions: 14 to 20

• Pause: between 60 to 90 seconds.

Depending on the condition of the patient, a gradual reduction of the number of sessions while increasing intensity is recommended, reducing the number of repetitions and increasing the resting times between each series.