Overview of Achilles tendon and its injuries
Achilles tendon is a group of tough tissues that connect the heel bone to the muscles of the lower leg. It is the strongest tendon in the body since it bears the entire body weight of an individual. Many of our day to day activities like walking, running, jumping and standing on toes are totally dependent on the Achilles tendon. This tendon is capable of carrying three to twelve times the body weight of an individual while performing strenuous activities such as pushing weights, running or climbing a rough terrain.
Many injuries and strains can cause pain in the Achilles tendon. Wear and tear related to overuse (running or walking for long time), problems in the structure of the tendon or other related tissues (such as shortened leg muscles or tendons, heel abnormalities, unequal length of the leg), wearing inappropriate shoes (with little cushion, no heel support, worn out shoes) and accidents involving the lower leg are some of the factors associated with an increased risk of injury to the Achilles tendon. Administration of certain drugs belonging to the group of quinolones or cortisones has also been noted to increase the risk of Achilles tendon rupture.
Types of Achilles tendon injuries/inflammatory conditions
• Tendonitis/achilles tendinosis is characterized by stiffness or soreness in the tendon which worsens gradually. The soreness can be easily identified by pinching the tendon. Typical features include pain progression over a period of time which subsides on rest. The tendon may also be painful to touch. If the pain persists for few weeks or months then it is referred to as chronic tendonitis.
• Tendon rupture refers to tear of the tendon which could be either a complete or a partial tear depending upon the intensity of the injury.
• Tendon bursitis refers to the inflammation of the tissues around the tendon which provide a cushioning to the joints. Achilles tendon bursitis is generally characterized by the presence of a warm tender spot and swelling at the back of the heel.
How is Achilles tendon injuries treated?
The treatment options for different tendon abnormalities vary, but fundamentally rehabilitation exercises are beneficial in all types of Achilles tendon defects.
In case of tendonitis, the pain usually lasts for a few weeks and adequate pain control is the preliminary step in treatment. Application of icepacks, three times a day, for 15-20 minutes, for a few days is usually advised. Use of crutches to give rest to the heel is also advised. Other measure includes taping of the tendon to support it and prevent further trauma. The underlying cause for the tendonitis should be picked out (high heels, wrong shoes, and strenuous exercise) and corrected to get a complete cure.
Medications that relieve the inflammation and pain are given for a few days. In case of tendon rupture, surgical or non surgical methods of treatment are advised for correction of the ruptured tendon. Both these procedures will require the foot be in a cast for duration of 6 weeks. Surgical repair of tendons prevent re-rupture. Non surgical measures involve the use of certain specialized devices such as orthotics, casts, and braces for a few weeks.
Treatment of bursitis involves application of ice and heat compress, injection of local anesthetics or steroids into the inflamed tissues. Foam rubber padding in the shoe, or felt pads can be used for decreasing pressure on the foot as well to reduce irritation to the tissues supporting the ankle joint.
Rehabilitation exercises for Achilles tendonitis
These exercises help in improving flexibility of the tendons and aids in pain free performance of the daily activities. The stretching exercises should be done routinely for a long period of time. The frequency should be more in the initial phase of tendon problems. The leg and foot muscles are the target for Achilles tendon stretches. Stretching of muscles of the lower leg is important and it includes stretching of the muscles known as gastrocnemius and soleus.
• Gastrocnemius stretching: is done while keeping the leg straight
• Soleus stretching: is done with bent leg
In addition to stretch exercises, massage to the tendons can also help in smooth sliding of tendons and improve the elasticity of the calf muscles.
These exercise aim to strengthen the Achilles tendon as well as the calf muscles. The tendon should be stretched before being strengthened. Heel dropping and raining exercise are widely used in the treatment of tendonitis.
Balance/ proprioception/ neural co-ordination exercises
A severe injury to the tendon can affect the neural coordination of the ankle and prolonged rest can also have adverse outcome on coordination. Development of balance is an important concept in those who have rested their leg for prolonged period of time. Exercising by balancing on one foot can help in regaining balancing ability of the feet. Apart from balance training, this exercise strengthens the ankle as well prevents further injuries to the tendon. Wobble board exercises are usually used for balance training.
Rehabilitation in Achilles tendon rupture
Immobilization of the foot is the immediate treatment for rupture as so is surgery, in most of the cases. Strengthening, stretching exercises are not followed for rupture of tendons before and immediately after surgery as it will be detrimental; participating in any physical activity can worsen the rupture and might make surgery the only option available for treatment. The same procedure is followed for tendon crushes and tears.
Read More: Peroneal Tendonitis
Rehabilitation tips for Achilles tendon conditions
Rehabilitation tips are similar for all tendon abnormalities and are aimed at prevention of recurrence as well as the management of pain.
• Exercise intensity should be steadily increased over time as well the duration of training
• Training on soft surfaces should be prevented as the heels sinks in the soft surface making it more susceptible to further injury
• Warming up before starting exercise should always be done
• Appropriate shoes for particular type of activity must be worn
• A continuous level of activity should be done every day to keep the heel and associated tendons flexible
• Overall conditioning of leg and calf muscles needs to be done to maintain fitness