Achilles tendon pathology can be separated into several catogies. Paratenosis, or inflamation to the soft tissue surrounding and bringing blood supply to the tendon, Tendonitis, or inflamation of the tendon itself, and finally Tendonosis, or a severe case of loss of blood supply to the paratenon and tendon; a stage with which cell death and rupture can occur.
Most achilles tendon problems arise from a tightening or contraction of the tendon over time combined with over-pronation or fall of the arch of the foot. The achilles tendon twists on itself about 30 degrees in a medial direction from the knee to the back of the heel. As the tendon contracts, this twist can create a “wringing-out” effect on the paratenon and tendon which starves the tendon of vitaly needed nutritional blood supply and can lead to cell death in the chronic situation. This creates inflamation, necrosis and can eventually lead to micro-tears, or complete rupture.
How do I treat my achilles tendonitis?
All treatment should be geared around increasing the elasticity and length of the contracted tendon, although for advanced cases immobilization and rest may be the first line of care. At Barrett Podiatry we will evaluate and determine just how much contracture of your achilles tendon has occured and what is your Achilles Tendon’s level of injury. Accomplishing tendon elasticity may be had by carefully and personally designed stretching techniques and with custom orthotics designed to decreased the pronation at the foot arch.
For advanced cases custom foot and ankle bracing may need to be employed along with a possible period of immobilization or off loading the foot. Surgery is often the best definitive option to rapidly eliminate the pathologic chronically inflammed or torn achilles tendon. Often times there is a significant Heel Spur which has developed into the achilles tendon at the back of the heel. In such cases surgery can again be the best option for eliminating this chronic painful condition.