Achilles Heel (Achilles Tendinitis)

Achilles tendinitis is inflammation of the Achilles tendon, which is the tough band of ligament extending from the calf muscles to the heel. The inflammation can be a result of being kicked directly, or a result of regular stress, where the elasticity of the tendon cannot cope with the blood flow (that is, the tendon is not elastic enough). In other words, this injury can just happen inexplicably and out of the blue. The calf muscles and the Achilles tendon work together to lower the forefoot after the heel touches the ground, and raise the heel as the toes push off just before stepping to the other foot.

How is it caused?

Achilles tendinitis occurs when stresses placed on the tendon are greater than the tendon's strength. Running downhill places extra stress on the Achilles tendon because the forefoot has farther to go before touching the ground. Running uphill also stresses this tendon because the calf muscles must exert greater force to raise the heel as the toes push off. Improper shoes or boots can contribute. A soft heel counter (the back part of the shoe that surrounds the heel) can allow excessive movement of the heel, stressing the Achilles tendon unevenly and increasing the likelihood that it will tear. Stiff-soled shoes that do not bend where the toes join the foot place great stress on the Achilles tendon just before the toes push off.

Various functional and structural abnormalities predispose the Achilles tendon to injury. These abnormalities include rolling the feet onto the outside (also called "pronation") excessively, the habit of landing too far back on the heel (checking the sole of the running shoe can show where the heel is most worn), bowed legs, tight hamstring and calf muscles, high arches, tight Achilles tendons, and heel deformities. The Achilles tendon is enclosed in a protective sheath; between the tendon and its sheath is a thin layer of fat, which enables the tendon to move freely. When the tendon is injured, scars form between it and its sheath, causing the tendon to pull on the sheath with each movement.

Preventing Achilles Tendinitis

Stretch properly before exercise. To stretch properly, get your heart rate up to its normal athletic rate by walking a half lap around the field, gradually increasing the pace, and then run the other half lap. Repeat as necessary. Spend 5-10 minutes warming up. Then perform Achilles stretches as described in ??????????????.

If you get injured, don't make it worse

Pain, the major symptom, is usually most severe when you start to move. It is often relieved by continuing to walk or run despite the pain and stiffness. Continuing to walk or run relieves the pain because it increases the temperature of the sheath, making it more pliable, so that the tendon can move more freely. If you ignore the pain and continue to run, rigid scar tissue replaces the elastic tendon, and the tendon will always hurt during exercise, with virtually no chance of a cure. Refraining from running and from pedaling a bicycle as long as the pain persists is an important part of treatment.

Other measures depend on the probable cause or predisposing conditions and include wearing shoes with flexible soles and placing heel lifts in running shoes to reduce tension on the tendon and stabilize the heel. The blood flow to the Achilles tendon is reduced when the foot is bent upwards; a heel wedge reduces this effect. Exercises to stretch the hamstring muscles can be started as soon as they can be done without pain. Exercises to strengthen the Achilles tendon, such as toe raises, are helpful. After running is resumed, you should not run uphill or downhill at a fast pace until the tendon is fully healed-which can be weeks to years later. Surgery may be required.