What is Achilles Tendonitis

Achilles tendonitis

This is inflammation of the achilles tendon, usually resulting from overuse but can also be associated with a change in footwear, intensity of an activity or a poor diet.

The Achilles tendon (or occasionally Achilles’ tendon), also known as the calcaneal tendon or the tendo calcaneus, is a tendon of the posterior leg. It serves to attach the gastrocnemius and soleus muscles (calf muscles) to the calcaneus (heel) bone.

The achilles tendon passes behind the ankle. It is the thickest and strongest tendon in the body. It is about 15 cm long, and begins near the middle of the calf gradually becoming smaller until it attaches to the heel bone.

The Achilles tendon is surrounded by a connective tissue sheath  called the paratenon, rather than a true synovial sheath. The paratenon stretches with movement, allowing maximum gliding action. Near the insertion of the tendon are two bursa, the subcutaneous calcaneal and the retrocalcaneal bursa.

Epidemiology, causes of achilles tendonitis

• Achilles tendonitis occurs in sports such as running, jumping, dancing and tennis.
• Other risk factors include participation in a new sporting activity or increasing the intensity of participation.
• Poor running technique, excessive pronation of the foot and poorly fitting or non shock absorbing footwear may contribute.
• In cyclists, the problem may be a low saddle, which causes extra dorsiflexion of the ankle when pedalling.
• Quinolone antibiotics (e.g. ciprofloxacin, ofloxacin) or a diet that is low in protein and high in carbohydrates can cause inflammation of tendons and predispose them to rupture.

Presentation and symptoms

• Gradual onset of pain and stiffness over the tendon, which may improve with heat or walking and worsen with strenuous activity.
• Tenderness of the tendon on palpation. There may also be crepitus (creaking) and swelling.
• Pain on active movement of the ankle joint.
• Rupture of the tendon should be looked for.

The most common Achilles tendon injuries are Achilles tendinosis, formerly known as, Achilles tendonitis and Achilles tendon rupture. Achilles tendinosis is inflammation of the tendon, generally due to overuse. Partial and full Achilles tendon ruptures are most likely to occur in sports requiring sudden eccentric stretching, such as sprinting. 

Why is achilles tendonitis so difficult to heal?

A tendon is a strong, flexible tissue that attaches muscles to bones.  A normal tendon is sleek and smooth and glides effortlessly through the surrounding tissues.

When a tendon has been damaged or part of it has become inflamed through over-use,  it no longer slides smoothly and instead it rubs against the surrounding tissue, which leads to even more inflammation and pain.

The reason that tendons are so slow to heal is that they have very poor blood supplies compared to other areas of the body such as muscle or skin, both of which require lots of oxygen in order to do their job. Unfortunately, tendons don't require a lot of blood to carry out their function, so consequently they have a much reduced blood supply, which means they normally take a very long time to heal.

How can I heal achilles tendonitis?

The normal medical advice for healing a damaged tendon is 'complete rest', as this allows the inflammation to subside and new cells to gradually replace the damaged ones. However, due to the poor blood supply that tendons have, it can take a very long period of inactivity to completely heal the tendon.

Thankfully, due to the development of the MAD-1 there is no longer any need to keep on suffering. The MAD-1 uniquely combines two highly effective forms of treatment, which provides the most rapid reduction of pain and inflammation and quickest healing times possible for achilles tendonitis.