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March 16, 2014
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Achilles tendinitis is generally viewed as an overuse injury of the Achilles tendon, the band of tissue that connects the calf muscles to the back of the foot.  Achilles tendinitis is often seen in runners who have suddenly increased the intensity or duration of their runs. It is also common in middle-aged people who play sports on the weekends or somewhat infrequently.  The injury results in inflammation and minor tears within the tendon.   More serious cases may result in larger tears and/or partial or complete ruptures requiring surgical repair.  The injury is first evaluated by physical examination for changes in the achilles tendon.  Diagnostic ultrasound may be used to visualize the tendon.  Ultimately, an MRI may be ordered to best determine the extent of the injury.   Radiographs can be ordered if bony injury is suspected.

The achilles tendon does not receive a good blood supply.  Therefore, healing may take an extended amount of time.   It is not unusual for healing to take multiple weeks or even months.  Common treatments include icing, taking anti-inflammatory medications, supportive shoes and heel lifts, limiting activity and physical therapy.  In more severe cases, using crutches and/or a walking boot are beneficial to decrease the stresses on the achilles tendon and provide rest to the area.   I like to say that if we have an "overuse" injury, then "underusing" it is important for it to heal.  

I like to utilize night splints to hold the foot in a neutral position while the patient sleeps.   This prevents the achilles tendon from tightening up overnight in a shortened position, while not putting too much tension on the fibers of the tendon.  

Achilles tendon injuries are relatively common and efforts to lower your chances of an issue developing are worth taking.   Performing stretching exercises of the calf muscles increases flexibility and lowers the risk of injury.   Supportive shoes and sneakers support the arch and result in less pull being applied by the achilles tendon.  Finally, gradually increasing the intensity of any new sport or exercise is highly recommended.