| Achilles tendonitis | |
|---|---|
| Classification and external resources | |
| ICD-10 | M76.6 |
| ICD-9 | 726.71 |
| DiseasesDB | 31726 |
| eMedicine | sports/2 |
Achilles tendonitis (also Achilles tendinopathy) is tendonitis of the Achilles tendon, generally caused by overuse of the affected limb and is more common among athletes training in under less than ideal conditions. It should not be confused with xanthoma of the tendon, which is the accumulation of cholesterol in patients with familial hypercholesterolemia.
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The Achilles tendon does not have good blood supply or cell activity, so this injury can be slow to heal. The tendon receives nutrients from the tendon sheath or paratendon. When an injury occurs to the tendon, cells from surrounding structures migrate into the tendon to assist in repair. Some of these cells come from blood vessels that enter the tendon to provide direct blood flow to increase healing. With the blood vessels come nerve fibers. Researchers including Alfredson and his team in Sweden [7] believe these nerve fibers to be the cause of the pain - they injected local anaesthetic around the vessels and this decreased significantly the pain from the Achilles tendon.
Treatment is possible with ice, cold compression therapy, wearing heel pads to reduce the strain on the tendon, and an exercise routine designed to strengthen the tendon. Some people have reported vast improvement after applying light to medium compression around ankles and lower calf by wearing elastic bandages throughout the day. Using these elastic bandages while sleeping can reduce morning stiffness but care must be taken to apply very light compression during sleep. Compression accelerates healing by improving circulation.[1] Seeing a professional for treatment as soon as possible is important, because this injury can lead to an Achilles tendon rupture with continued overuse. Other treatments may include non-steroidal anti-inflammatory drugs, such as ibuprofen, ultrasound therapy, manual therapy techniques, a rehabilitation program, and in rare cases, application of a plaster cast. Steroid injection is sometimes used, but must be done after very careful, expert consideration because it can increase the risk of tendon rupture[3]. There have recently been some interest in the use of autologous blood injections, however the results have not been highly encouraging and there is little evidence for its use[4]. However results over several years have shown that injection of saline deep to the tendon (High Volume injection) under ultrasound guidance carries a very high success rate and relatively rapid return to sport. [5] [6] This technique was pioneered by Otto Chan and Tom Crisp at London Independent Hospital. Severe cases may require surgery from an orthopedic surgeon or podiatric surgeon.
More specialised therapies include prolotherapy (sclerosant [whatever that is] injection into the neovascularity) and extracorporeal shockwave therapy (ESWT). Efficacy and evidence for prolotherapy is limited.
Prevention includes following appropriate exercise habits and wearing low-heeled shoes. A physical therapist or athletic trainer can prescribe safe exercise methods.
3. Maffulli et al.(2010). Novel Approaches for the Management of Tendinopathy. J. Bone Joint Surg. Am., 92(15);2604-13.
4.Limited Evidence Supports the Effectiveness of Autologous Blood Injections for Chronic Tendinopathies
5. http://dx.doi.org/10.1080/09638280701788225 Otto Chan et al. High Volume Imaging guided injections in chronic Achilles tendinopathy Disability & rehabilitation 2008, Vol. 30, No. 20-22 , Pages 1697-1708
6. http://www.sciencedirect.com/science/article/pii/S1440244009002230 Humphrey J et al. The short term effects of high volume image guided injections in resistant non-insetional Achilles tendinopathy.Journal of Science and Medicine in Sport Volume 13, Issue 3, May 2010, Pages 295-298
7.Alfredson et al Is vasculo-neural ingrowth the cause of pain in chronic Achilles tendinosis? An investigation using ultrasonography and colour Doppler, immunohistochemistry, and diagnostic injections. Knee Surg Sports Traumatol Arthrosc. 2003 Sep;11(5):334-8.
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