Foot Bunions Causes

Overview
Bunions Callous A bunion is an unnatural, bony hump that forms at the base of the big toe where it attaches to the foot. Often, the big toe deviates toward the other toes. When this occurs, the base of the big toe pushes outward on the first metatarsal bone, which is the bone directly behind the big toe, forming a bunion. If this happens on the little toe and fifth metatarsal, it's called a bunionette. Because a bunion occurs at a joint, where the toe bends in normal walking, your entire body weight rests on the bunion at each step. Bunions can be extremely painful. They're also vulnerable to excess pressure and friction from shoes and can lead to the development of calluses.

Causes
Bunions can be caused by the following factors. Hereditary (especially via the female line). Rolling in (pronation) of the feet. Walking with turned out feet. Weakness of muscles controlling the big toe. Weakness of intrinsic muscles of the feet. Leaning on the big toe in a tendu, especially to second or derri?re. Reduced mobility of the big toe when on demi-pointe. Restricted pointe range.

Symptoms
With Bunions, a person will have inflammation, swelling, and soreness on the side surface of the big toe. Corns most commonly are tender cone-shaped patches of dry skin on the top or side of the toes. Calluses will appear on high-pressure points of the foot as thick hardened patches of skin.

Diagnosis
Your doctor will ask questions about your past health and carefully examine your toe and joint. Some of the questions might be: When did the bunions start? What activities or shoes make your bunions worse? Do any other joints hurt? The doctor will examine your toe and joint and check their range of motion. This is done while you are sitting and while you are standing so that the doctor can see the toe and joint at rest and while bearing weight. X-rays are often used to check for bone problems or to rule out other causes of pain and swelling. Other tests, such as blood tests or arthrocentesis (removal of fluid from a joint for testing), are sometimes done to check for other problems that can cause joint pain and swelling. These problems might include gout , rheumatoid arthritis , or joint infection.

Non Surgical Treatment
Pain is the main reason that you seek treatment for bunion. Analgesics may help. Inflammation it best eased via ice therapy and techniques or exercises that deload the inflammed structures. Anti-inflammatory medications may help. Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include ice, electrotherapy, acupuncture, deloading taping techniques, soft tissue massage and orthotics to off-load the bunion. As your pain and inflammation settles, your physiotherapist will turn their attention to restoring your normal toe and foot joint range of motion and muscle length. Treatment may include joint mobilisation and alignment techniques, massage, muscle and joint stretches, taping, a bunion splint or orthotic. Your physiotherapist is an expert in the techniques that will work best for you. Your foot posture muscles are vital to correct the biomechanics that causing your bunion to deteriorate. Your physiotherapist will assess your foot posture muscles and prescribe the best exercises for you specific to your needs. During this stage of your rehabilitation is aimed at returning you to your desired activities. Everyone has different demands for their feet that will determine what specific treatment goals you need to achieve. For some it be simply to walk around the block. Others may wish to run a marathon or return to a labour-intensive activity. Your physiotherapist will tailor your rehabilitation to help you achieve your own functional goals. Bunions will deform further with no attention. Plus, the bunion pain associated does have a tendency to return. The main reason is biomechanical. In addition to your muscle control, your physiotherapist will assess your foot biomechanics and may recommend either a temporary off-the shelf orthotic or refer you to a podiatrist for custom made orthotics. You should avoid wearing high heel shoes and shoes with tight or angular toe boxes. Your physiotherapist will guide you. Bunion Pain

Surgical Treatment
If all nonsurgical measures fail to control the symptoms, then surgery may be suggested to treat the hallux valgus condition. Well over 100 surgical procedures exist to treat hallux valgus. The basic considerations in performing any surgical procedure for hallux valgus are to remove the bunion, to realign the bones that make up the big toe, to balance the muscles around the joint so the deformity does not return.

Prevention
The simplest way to reduce your chance of developing foot bunion or bunionette problems is to wear good-fitting shoes. Avoid high heels as they push your feet forwards to the front of the shoe where they get squashed. Also avoid narrow fitting shoes, especially those that are pointed at the front with a narrow toe box as again, these place pressure through the toes pushing them inwards. Shoes should be comfortable and leave enough room for you to wiggle your toes. Remember, bunions rarely affect non-shoe wearing people. Exercising your feet can also help. By strengthening the foot muscles you can improve your foot position which can help reduce foot bunion problems. Simple exercises like picking up small objects with your toes can help.

Over-Pronation

Overview

Too much of a good thing can be bad, and when it comes to pronation of the foot this is often the case. When the foot rolls too much during contact with the ground, the body weight is not cushioned effectively. The degree to which pronation occurs may be difficult to spot without someone observing how you run. It is easier to tell if a runner is pronating excessively when they are observed from behind rather than from above. When overpronation is only mild to moderate it may not be easy to spot without having a professional gait analysis performed.Over-Pronation

Causes

There are many biomechanical issues that can contribute to excessive pronation, including weak foot intrinsic muscles, limited ankle dorsiflexion mobility and calf flexibility, weak ankle invertor muscles (e.g. posterior tibialis), weak forefoot evertor muscles (peroneus longus), poor hip strength and control, Anterior pelvic tilting, heel InversionIn a person who overpronates, the heel bone goes into an everted position meaning that it turns out away from the midline of the body. The opposite motion of eversion is inversion. Inversion is a motion that needs to be controlled to prevent the foot from excessively pronating.

Symptoms

Because overpronation affects the entire lower leg, many injuries and conditions may develop and eventually cause problems not only in the leg and foot, but also the knee, hips and lower back. Pain often begins in the arch of the foot or the ankle. Blisters may develop on the instep, or on the inside edge of the heels. As overpronation continues and problems develop, pain will be felt elsewhere, depending on the injury.

Diagnosis

Look at your soles of your footwear: Your sneaker/shoes will display heavy wear marks on the outside portion of the heel and the inside portion above the arch up to the top of the big toe on the sole. The "wet-foot" test is another assessment. Dip the bottom of your foot in water and step on to a piece of paper (brown paper bag works well). Look at the shape of your foot. If you have a lot of trouble creating an arch, you likely overpronate. An evaluation from a professional could verify your foot type.Over Pronation

Non Surgical Treatment

Although there is no actual cure for over-pronation it is possible to correct or at least reduce this problem. In order to restore our normal foot function an 'orthotic' or orthotic insole device is placed inside the shoes. Orthotics are designed to realign the foot and ankle bones to their natural position. This in turn restores our normal foot function and it helps alleviate not only foot problems but also ailments in other parts of the body i.e. the legs, knees and lower back. In addition to wearing an orthotic, it is recommended to wear supportive shoes, like good quality athletic footwear with a firm heel counter and sufficient flexibility in the forefoot area.

Prevention

Exercises to strengthen and stretch supporting muscles will help to keep the bones in proper alignment. Duck stance: Stand with your heels together and feet turned out. Tighten the buttock muscles, slightly tilt your pelvis forwards and try to rotate your legs outwards. You should feel your arches rising while you do this exercise. Calf stretch: Stand facing a wall and place hands on it for support. Lean forwards until stretch is felt in the calves. Hold for 30 seconds. Bend at knees and hold for a further 30 seconds. Repeat 5 times. Golf ball: While drawing your toes upwards towards your shins, roll a golf ball under the foot between 30 and 60 seconds. If you find a painful point, keep rolling the ball on that spot for 10 seconds. Big toe push:

Stand with your ankles in a neutral position (without rolling the foot inwards). Push down with your big toe but do not let the ankle roll inwards or the arch collapse. Hold for 5 seconds. Repeat 10 times. Build up to longer times and fewer repetitions. Ankle strengthener: Place a ball between your foot and a wall. Sitting down and keeping your toes pointed upwards, press the outside of the foot against the ball, as though pushing it into the wall. Hold for 5 seconds and repeat 10 times. Arch strengthener: Stand on one foot on the floor. The movements needed to remain balanced will strengthen the arch. When you are able to balance for 30 seconds, start doing this exercise using a wobble board.

How Do I Cure Calcaneal Apophysitis From Home?

Overview

Sever's disease is a pain that occurs in the back of the heel of physically active children at around the time of puberty. Sever's disease occurs due to an inflammation of the growth plate due to excessive pull of the achilles tendon on this growth plate. During puberty the bones quite often grow faster than the muscles and tendons causing the tendons to become tight, this tightness then results in excessive pull on the back of the heel resulting in this painful condition.

Causes

During the growth spurt of early puberty, the heel bone (also called the calcaneus) sometimes grows faster than the leg muscles and tendons. This can cause the muscles and tendons to become very tight and overstretched, making the heel less flexible and putting pressure on the growth plate. The Achilles tendon (also called the heel cord) is the strongest tendon that attaches to the growth plate in the heel. Over time, repeated stress (force or pressure) on the already tight Achilles tendon damages the growth plate, causing the swelling, tenderness, and pain of Sever's disease. Such stress commonly results from physical activities and sports that involve running and jumping, especially those that take place on hard surfaces, such as track, basketball, soccer, and gymnastics.

Symptoms

Athletes with Sever?s disease are typically aged 9 to 13 years and participate in running or jumping sports such as soccer, football, basketball, baseball, and gymnastics. The typical complaint is heel pain that develops slowly and occurs with activity. The pain is usually described like a bruise. There is rarely swelling or visible bruising. The pain is usually worse with running in cleats or shoes that have limited heel lift, cushion, and arch support. The pain usually goes away with rest and rarely occurs with low-impact sports such as bicycling, skating, or swimming.

Diagnosis

This condition is self limiting, it will go away when the two parts of bony growth join together, this is natural. Unfortunately, Sever's disease can be very painful and limit sport activity of the child while waiting for it to go away, so treatment is often advised to help relieve it. In a few cases of Sever's disease, the treatment is not successful and these children will be restricted in their activity levels until the two growth areas join, usually around the age of 16 years. There are no known long term complications associated with Sever's disease.

Non Surgical Treatment

Treatment is primarily directed towards reducing the amount of stress to the heel. Often a heel lift, is placed in the shoe to reduce the pull of the Achilles tendon on the apophysis. Gel or cushioned heel cups may also be helpful in reducing micro trauma to the heel. Orthotic control may also be indicated when a pathologic condition exists in the foot that may be contributing to the increased heel stress. Occasionally, it becomes necessary for adequate healing, to rest the area completely. This can be accomplished either by complete elimination of all strenuous activities, or by using a walking cast or crutches. Often simply reducing activity levels is adequate. Your physician will discuss the best treatment plan with you and your child.

Prevention

Maintain good flexibility through stretching exercises. Avoid excessive running on hard surfaces. Use quality, well-fitting shoes with firm support and a shock-absorbent sole.

What Are The Primary Causes Of Adult Aquired Flat Foot ?

Overview
Posterior tibial tendon dysfunction (PTTD) is an inflammation and / or overstretching of the posterior tibial tendon in the foot. An important function of the posterior tibial tendon is to help support the arch. But in PTTD, the tendon?s ability to perform that job is impaired, often resulting in a flattening of the foot. PTTD is often called ?adult-acquired flatfoot? because it is the most common type of flatfoot developed during adulthood. Although this condition typically occurs in only one foot, some people may develop it in both feet. PTTD is usually progressive, which means it will keep getting worse-especially if it isn?t treated early. This differs from flexible flatfoot because flexible flatfoot typically begins in childhood or adolescence and continues into adulthood. It usually occurs in both feet and generally progresses in severity throughout the adult years. As the deformity worsens, the soft tissues (tendons and ligaments) of the arch may stretch or tear and become inflamed. The term ?flexible? means that while the foot is flat when standing (weight bearing), the arch returns when not standing. In the early stages of flexible flatfoot arthritis is not restricting motion of the arch and foot, but in the later stages arthritis may develop to such a point that the arch and foot become stiff. Adult Acquired Flat Foot

Causes
Damage to the posterior tendon from overuse is the most common cause for adult acquired flatfoot. Running, walking, hiking, and climbing stairs are activities that add stress to this tendon, and this overuse can lead to damage. Obesity, previous ankle surgery or trauma, diabetes (Charcot foot), and rheumatoid arthritis are other common risk factors.

Symptoms
Pain along the inside of the foot and ankle, where the tendon lies. This may or may not be associated with swelling in the area. Pain that is worse with activity. High-intensity or high-impact activities, such as running, can be very difficult. Some patients can have trouble walking or standing for a long time. Pain on the outside of the ankle. When the foot collapses, the heel bone may shift to a new position outwards. This can put pressure on the outside ankle bone. The same type of pain is found in arthritis in the back of the foot. Asymmetrical collapsing of the medial arch on the affected side.

Diagnosis
Observation by a skilled foot clinician and a hands-on evaluation of the foot and ankle is the most accurate diagnostic technique. Your Dallas foot doctor may have you do a walking examination (the most reliable way to check for the deformity). During walking, the affected foot appears more pronated and deformed. Your podiatrist may do muscle testing to look for strength deficiencies. During a single foot raise test, the foot doctor will ask you to rise up on the tip of your toes while keeping your unaffected foot off the ground. If your posterior tendon has been attenuated or ruptured, you will be unable to lift your heel off the floor. In less severe cases, it is possible to rise onto your toes, but your heel will not invert normally. X-rays are not always helpful as a diagnostic tool for Adult Flatfoot because both feet will generally demonstrate a deformity. MRI (magnetic resonance imaging) may show tendon injury and inflammation, but can?t always be relied on for a complete diagnosis. In most cases, a MRI is not necessary to diagnose a posterior tibial tendon injury. An ultrasound may also be used to confirm the deformity, but is usually not required for an initial diagnosis.

Non surgical Treatment
There are many non-surgical options for the flatfoot. Orthotics, non-custom braces, shoe gear changes and custom braces are all options for treatment. A course of physical therapy may be prescribed if tendon inflammation is part of the problem. Many people are successfully treated with non-surgical alternatives. Flat Feet

Surgical Treatment
Stage two deformities are less responsive to conservative therapies that can be effective in mild deformities. Bone procedures are necessary at this stage in order to recreate the arch and stabilize the foot. These procedures include isolated fusion procedures, bone grafts, and/or the repositioning of bones through cuts called osteotomies. The realigned bones are generally held in place with screws, pins, plates, or staples while the bone heals. A tendon transfer may or may not be utilized depending on the condition of the posterior tibial tendon. Stage three deformities are better treated with surgical correction, in healthy patients. Patients that are unable to tolerate surgery or the prolonged healing period are better served with either arch supports known as orthotics or bracing such as the Richie Brace. Surgical correction at this stage usually requires fusion procedures such as a triple or double arthrodesis. This involves fusing the two or three major bones in the back of the foot together with screws or pins. The most common joints fused together are the subtalar joint, talonavicular joint, and the calcaneocuboid joint. By fusing the bones together the surgeon is able to correct structural deformity and alleviate arthritic pain. Tendon transfer procedures are usually not beneficial at this stage. Stage four deformities are treated similarly but with the addition of fusing the ankle joint.

Pain In The Foot's Arch Cause And Effect

Overview

Most flat feet are not painful, particularly those flat feet seen in children. In the adult acquired flatfoot, pain occurs because soft tissues (tendons and ligaments) have been torn. The deformity progresses or worsens because once the vital ligaments and posterior tibial tendon are lost, nothing can take their place to hold up the arch of the foot. The painful, progressive adult acquired flatfoot affects women four times as frequently as men. It occurs in middle to older age people with a mean age of 60 years. Most people who develop the condition already have flat feet. A change occurs in one foot where the arch begins to flatten more than before, with pain and swelling developing on the inside of the ankle. Why this event occurs in some people (female more than male) and only in one foot remains poorly understood. Contributing factors increasing the risk of adult acquired flatfoot are diabetes, hypertension, and obesity.

Arch Pain

Causes

Often, tarsal tunnel syndrome is misdiagnosed and confused with plantar fasciitis. Tarsal tunnel syndrome is when the tibial nerve which runs through the ankle, is pinched as it passes through the flexor retinaculum, the supportive band that surrounds the ankle joint. The symptoms of tarsal tunnel syndrome are often limited to the ankle but the since the nerve passes through the entire foot it can cause arch pain. Arch pain associated with foot strain is mainly caused by a pronated foot (rolls inward) or a flat foot. These are usually not singular causes of arch pain, but in combination with other factors, arch pain may result.

Symptoms

Common symptoms of plantar fasciitis include pain in the morning when you first get out of bed, pain and stiffness when you start to walk after sitting for a while, increasing arch or heel pain toward the end of the day, tired feet at the end of the day. Other causes of arch and heel pain include arthritis, infection, fractures and sprains, and even certain systemic diseases. Since there are multiple possible causes, you should see your podiatrist for a thorough evaluation if you are experiencing arch or heel pain that does not respond quickly to early treatment.

Diagnosis

The doctor will take a brief history to determine how the injury occurred. If necessary, a thorough physical exam may be conducted to evaluate for any other injuries. Taking your workout shoes to the exam may also provide valuable information to the medical practitioner. Both feet will be physically and visually examined by the medical practitioner. The foot and arch will be touched and manipulated possibly with a lot of pressure and inspected to identify obvious deformities, tender spots, or any differences in the bones of the foot and arch.

Non Surgical Treatment

If it is flat feet, then you'd seek professional advice and maybe need orthotics, or arch supports to prevent the pressures and to stop the pain. One of the other reasons you can get pain in this area of the foot is plantar fasciitis. The plantar fascia is a membrane that is inside of the skin and attaches to the heel bone here. It divides into three bands that go out of the foot here: the outer band, the central band, and the medial band here. Often, from impact, you get an inflammation of that attachment to the heel bone and this can often spread up the medial band and this is another way of getting pain in that arch. Now, the way to treat that is also using arch supports but also heel cushions, better soled shoes to prevent the pressure. These things normally disappear after a year, 18 months. Plantar fasciitis is easier to treat because it's not a long term problem. If you do need arch support, something like this would be very good for both problems.

Pain In Arch

Surgical Treatment

The main goal of surgery is to reduce pain and improve function. It may also reduce other injuries such as repeated ankle sprains and broken bones. Surgery may be considered if there is no relief with physical therapy, changes in shoewear and/or changes in activity. Some patients will also have tendon problems, ankle weakness and foot fractures. These patients may require other procedures to address related problems. If you have medical problems that make surgery unsafe, any infections or blood vessel disease, cavus foot surgery may not be appropriate. The surgical procedures involved with the correction of the cavus foot are varied. Theses may include correction of the bony deformity, ankle looseness and the muscle imbalances that cause the deformity. The goal is to provide a foot that evenly distributes weight along both inside and outside edges. A variety of incisions may be needed to perform the procedures related to the correction of the cavus foot.

Stretching Exercises

Point your toes. To ease foot pain and aching in your feet, lift one foot and roll it downward until the toes are pointed toward the ground. Then flex your foot. Repeat using the other foot. This exercise will help stretch out all the small muscles that are on the bottom of your feet, which can help relieve aching and improve blood circulation. Raise your heels. This exercise is good for relieving toe cramps caused by standing for hours in constricting shoes, says Kurtz. Bonus: It can also strengthen calf muscles and make them look more defined. Stand up and lift your heels so that you are standing on the balls of your feet. Hold for 10 seconds. Repeat 10 times. Squeeze your toes. To strengthen the toes and help alleviate foot pain from hammertoes (when a toe resembles a claw), separate your toes using corks or foam toe separators and then squeeze your toes together for five seconds. Repeat 10 times. Roll a ball. Want to create an instant massage for the bottom of your feet? Roll a golf ball or tennis ball under the ball of your foot. Apply light pressure for about two minutes. This exercise can be helpful for arch pain, cramps, and heel pain from plantar fasciitis. Stretch standing up. A weight-bearing, runners-type stretch can be helpful for foot pain in the arch. Stand up and place your toes against a wall; lean forward a little until you feel your arch stretch. Repeat using the other foot. Stretch sitting down. Sit barefoot and cross your left leg so that your ankle rests on your right thigh. Then hold your toes and bend them back toward your shin, stretching the band of tissue connecting the bottom of the heel to the ball. A University of Rochester study found that people living with plantar fasciitis had a 75 percent chance of having no pain within three to six months of performing this stretch three times daily. Give yourself a foot massage. Nothing spells pain relief like a good foot rub. Use the following technique recommended by Rhonda Crockett, a licensed massage therapist at Ohio State University?s Center for Integrative Medicine in Columbus. Start with your toes, using your thumb to massage them in circular motions. Then move to the arch under your foot and gradually work your way down to the heel, applying pressure with your fingers and palm of your hand. Use lotion to allow your hand to move smoothly over your foot. Relax in a warm bath with Epsom salts. The combination of warm water and Epsom salts will give you a double dose of pain relief and relaxation. Magnesium sulfate, the key compound in Epsom salts, has been found to relax muscles, reduce pain, and sedate the nervous system. Plus, warm water helps improve circulation in the feet and relieve muscle pain. Crockett recommends adding two cups of Epsom salts to a warm bath and soaking for 20 minutes.

An Achilles Tendon Rupture How Do I Know I Suffered One?

Overview Achilles Tendon Achilles tendon rupture are common. Most athletes describe a sudden acute event with an associated popping sensation and pain in the Achilles tendon. They often think that they have been kicked or struck in the calf. It is important to get prompt treatment and to be placed in an equinous cast (a cast with the foot in a pointed position). More definitive treatment options can be discussed after this has occurred. Causes Ruptured Achilles tendons may result from falling from a height or down a hole. Increasing training intensity abruptly, boosting distance, frequency or duration by more than 10% a week. Failing to stretch before and after exercise. Repetitive training, especially uphill running. Deyhydration, which causes cramping and tightness in the calves. Taking antibiotics. Improper footwear. Explosive movements in competitive sports like basketball, soccer or track & field. Symptoms If the Achilles tendon is ruptured you may experience a sudden pain in the back of your leg, as if someone had kicked you, followed by, swelling, stiffness, and difficulty to stand on tiptoe and push the leg when walking. A popping or snapping sound may be heard when the injury occurs. You may also feel a gap or depression in the tendon, just above heel bone. Ruptures usually occurs in those aged 30 - 70 years, during a sudden forceful push off from the foot. Without proper healing of the tendon, you will have a permanent limp and weakness when using the leg. Diagnosis Other less serious causes of pain in the back of the lower leg include Achilles tendonitis or bursitis. To distinguish between these possibilities, your physician will take a thorough history and examine your lower leg to look for signs of a rupture. The presence of a defect in the tendon that can be felt, evidence of weakness with plantarflexion, and a history consistent with Achilles tendon rupture are usually sufficient for diagnosis. Your physician may also perform a ?Thompson test,? which consists of squeezing the calf muscles of the affected leg. With an intact Achilles tendon, the foot will bend downward; however, with a complete rupture of the tendon, the foot will not move. In cases where the diagnosis is equivocal, your physician may order an MRI of the leg to diagnose a rupture of the Achilles tendon. Non Surgical Treatment The most widely used method of non-surgical treatment involves the use of serial casting with gradual progression from plantar flexion to neutral or using a solid removable boot with heel inserts to bring the ends of the tendon closer together. The advantage of a solid removable boot is that it allows the patient to begin early motion and is removable. Wide variability exists among surgeons in regards to the period of absolute immobilization, initiating range of motion exercises, and progression of weight bearing status. Achilles Tendonitis Surgical Treatment Operative treatment of Achilles tendon ruptures involves opening the skin and identifying the torn tendon. This is then sutured together to create a stable construct. This can be performed through a standard Achilles tendon repair technique or through a mini-incision technique (to read about the different types of techniques, look under ?Procedure? in Achilles Tendon Repair). By suturing the torn tendon ends together, they maintain continuity and can be mobilized more quickly. However, it is critical to understand that the return to normal activities must wait until adequate healing of the tendon has occurred. The potential advantages of an open repair of the Achilles tendon include, faster recovery, this means that patients will lose less strength. Early Range of Motion. They are able to move the ankle earlier so it is easier to regain motion. Lower Re-rupture Rate. The re-rupture rate may be significantly lower in operatively treated patients (2-5%) compared to patients treated non-operatively (8-15%). The main disadvantage of an open repair of the Achilles tendon rupture is the potential for a wound-healing problem which could lead to a deep infection that is difficult to eradicate, or a painful scar. Prevention To prevent Achilles tendonitis or rupture, the following tips are recommended. Avoid activities that place an enormous stress on the heel (for example, uphill running or excessive jumping). Stop all activity if there is pain at the back of the heel. If pain resumes with one particular exercise, another exercise should be selected. Wear proper shoes. Gradually strengthen calf muscles with sit-ups if prior episodes of Achilles tendonitis have occurred. Always warm up with stretching exercises before any activity. Avoid high-impact sports if prior episodes of Achilles tendon injury.

Non Insertional Achilles Tendonitis

Overview

Achilles TendinitisAchilles tendonitis is inflammation of the tendon, usually resulting from overuse associated with a change in playing surface, footwear or intensity of an activity. The Achilles tendon is surrounded by a connective tissue sheath (paratenon, or 'paratendon'), rather than a true synovial sheath. The paratenon stretches with movement, allowing maximum gliding action. Near the insertion of the tendon are two bursae - the subcutaneous calcaneal and the retrocalcaneal bursae.

Causes

Unusual use or overuse of the lower leg muscles and Achilles tendon is usually the cause of Achilles tendinitis. Repetitive jumping, kicking, and sprinting can lead to Achilles tendinitis in both recreational and competitive athletes. Runners, dancers, and athletes over age 65 are especially at risk. Sudden increases in training or competition can also inflame your Achilles tendon. For example, adding hills, stair-climbing, or sprinting to your running workout puts extra stress on your Achilles tendon. Improper technique during training can also strain the tendon. Intense running or jumping without stretching and strengthening your lower leg muscles can put you at risk regardless of your age or fitness level. Running on tight, exhausted, or fatigued calf muscles can put added stress on your Achilles tendon, as your tendon may not be ready to quickly start a workout after a period of inactivity. Direct blows or other injuries to the ankle, foot, or lower leg may pull your Achilles tendon too far and stretch the tissue. A hard contraction of the calf muscles, such as can happen when you push for the final sprint in a race, can strain the tendon. People whose feet roll inward, a condition called overpronation, are particularly at risk. Sometimes, shoes with too much heel cushioning put extra strain on the Achilles tendon.

Symptoms

Signs and symptoms of Achilles Tendinitis generally include pain and stiffness along your achilles tendon, especially in the morning. Pain in the back of your heel that gets worse with activity. Severe pain the day after exercising. Swelling that gets worse with activity. If you feel a pop in the back of your heel or bottom of you calf, you may have ruptured or torn you achilles tendon.

Diagnosis

If Achilles tendonitis is suspected, avoid any exercise or activity that causes the pain. It is advisable to see a doctor promptly so that an accurate diagnosis can be made and appropriate treatment recommended. The doctor will take a full medical history and will ask about the nature and duration of the symptoms. They will perform a physical examination of the affected area. Ultrasound scanning may be used to assess damage to the tendon or surrounding structures. Occasionally MRI (magnetic resonance imaging) may be recommended. The symptoms of Achilles tendonitis are often similar to symptoms of other conditions such as partial Achilles tendon rupture and heel bursitis. This can make diagnosis difficult and a referral to an orthopaedic specialist may be required in order for an accurate diagnosis to be made.

Nonsurgical Treatment

Achilles tendonitis will often respond to rest or changes in activity, stretching, or ice after activity. Non-steroidal anti- inflammatory drugs (NSAIDs), such as ibuprofen or naproxen may also help. Physical therapy focusing on stretching and strengthening, massage, alternating hot and cold baths, and ultrasound or sound waves can also help with healing and comfort. The temporary use of a heel lift or the insertion of an arch support, called an orthotic, into the shoe or sneaker can also help. Although seldom necessary, the ankle may be kept in a short leg cast or splint. Surgery is rarely needed but can remove bone spurs or the bony prominence of the heel bone. The injection of corticosteroids such as cortisone into the area of the Achilles tendon is usually avoided because it may cause the tendon to rupture.

Achilles Tendon

Surgical Treatment

If non-surgical approaches fail to restore the tendon to its normal condition, surgery may be necessary. The foot and ankle surgeon will select the best procedure to repair the tendon, based upon the extent of the injury, the patient?s age and activity level, and other factors.

Prevention

The following measures can significantly reduce the risk of developing Achilles tendonitis. Adequately stretch and warm up prior to exercise. Warm down and stretch after exercise. Choose footwear carefully and use footwear appropriate to the sport being undertaken. Use orthotic devices in footwear to correctly support the foot. Exercise within fitness levels and follow a sensible exercise programme. Develop strong, flexible calf muscles.