Achilles Tendonitis

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Overview

The Achilles tendon, connecting the calf muscles to the heel bone, is the strongest and largest tendon found in the body. Common Achilles tendon injuries in Singapore include Achilles tendon tears and Achilles tendonitis. Though they may sound similar, the two injuries are rather different. Unlike Achilles tendon tears, which happen when the Achilles tendon is partially or completely torn, Achilles tendonitis occurs when the Achilles tendon becomes inflamed. Without proper treatment, Achilles tendonitis may eventually lead to Achilles tendon tears.

There are two types of Achilles tendonitis, affecting different regions of the tendon. Noninsertional Achilles tendonitis is when the tendon fibres in the mid substance of the tendon are inflamed and overused resulting in a micro breakdown, swelling and thickening. On the other hand, insertional Achilles tendonitis revolves around inflammation and injury of the Achilles tendon at the insertion onto the calcaneal bone at the lower part of the heel. This can result in bone spurs, which are bumps of extra bone that form on the ends of bones.

Symptoms

Achilles tendonitis symptoms tend to start out with patients feeling a slight ache at the back of their legs or around the heels after participating in sports activities. Without the proper treatment and rest, this mild ache can become more severe, especially if the patient continues engaging in sports. Other symptoms also include difficulty walking and bending the ankle, pain in the ankle and Achilles tendon that lasts days, and swelling in the calf. Should you experience any of these symptoms, it is highly recommended to visit a healthcare professional to understand your condition better and get the appropriate Achilles tendonitis treatment in Singapore.

Causes

Repetitive and intense strain are common causes of Achilles tendonitis. Certain activities can exert extra pressure on the Achilles tendon. For instance, sports activities with repetitive motions such as jumping and landing or running on hard surfaces. In addition, failing to perform proper warmups and then engaging in high-intensity sports including running uphill or playing basketball may also increase the risk of straining your Achilles tendon. Beyond causes relating to sports, obesity, medications and wearing shoes without proper support are also contributing factors to Achilles tendonitis.

Risk Factors

While the above causes can be controlled and minimised, there are biological risk factors as well that can increase one’s risk of Achilles tendonitis including age, gender and physical traits. Achilles tendonitis is found to occur in men more than women and its risk increases as each individual ages. With regards to physical traits, those with a naturally flat arch in their foot are more prone to experiencing Achilles tendonitis due to the extra pressure placed on the Achilles tendon.

Prevention

Though we may not be able to control the biological factors that increase the risk of Achilles tendonitis, there are healthy lifestyle habits we can adopt to minimise our risk of injury to the Achilles tendon. Firstly, take the time to stretch your calf muscles daily. This improves flexibility and strengthens the calf muscles, enabling the Achilles tendon to better manage the stress and impact that comes with certain sports activities.

Secondly, take into consideration the shoes that you wear. Shoes may seem unimportant but the right shoes with the right support can be great at helping to reduce pressure and strain on the Achilles tendon. Always replace worn-out shoes and ensure that your shoes are well-cushioned and the soles have a firm arch. Alternatively, you can also get arch supports to be worn in your shoes.

Thirdly, slowly increase the intensity of your training. While going straight into a sports activity may save time, it exerts unnecessary strain on your Achilles tendon and muscles. Sports injuries can take weeks or even months to recover. Therefore, spending time to warm up and slowly increase the intensity of your workout is much safer and more viable than getting treatment and awaiting recovery.

Treatment

As Achilles tendonitis is less severe than Achilles tendon tears, there are home remedies you can try to help alleviate your symptoms. For a start, try heat pads to relax the muscles and improve blood circulation and use ice packs to reduce swelling if any. It is recommended to have plenty of rest and perform light stretching exercises to loosen the calf muscles. Non-steroidal anti-inflammatory drugs can also be consumed to help relieve pain.

If the pain and symptoms persist after practising the above self-care measures, then it is highly advisable to consult a healthcare professional. For non-surgical Achilles tendonitis treatments in Singapore, your doctor may introduce orthotic devices or physical therapy. The former involves a shoe insert or wedge to cushion and elevate the heel for ample support. The latter involves specific eccentric Achilles stretching and strengthening exercises to promote healing.

Typically, minimally invasive procedures are the last resort when it comes to Achilles tendonitis treatment. Your orthopaedic specialist may recommend PRP (platelet-rich plasma) injections to the Achilles tendon to help achieve some biological healing of the tendon. This minimally invasive procedure involves extracting some blood from the patient, centrifuging the blood to extract the platelets and injecting that under sterile conditions into the Achilles in the outpatient setting. Another minimally invasive procedure is to insert an arthroscope into the Achilles tendon and shave off the damaged tissue and bone. Typically, the patient experiences immediate pain relief and can start walking the next day.