Treatment of Achilles Tendonitis
The inflammatory response of the Achilles tendon is a secondary result of trauma and is usually induced by a lack of elasticity. It is generally an injury of athletes in sports requiring quick, short bursts of speed. Achilles tendonitis is generally caused by micro-trauma or tiny tears in the tendon. Upon palpation and active motion movements, the Achilles tendon region will be painful in the injured athlete.
Stretching of the Gastrocnemius-Soleus complex and plantar flexion of the foot will also be uncomfortable. Treatment of acute Achilles tendonitis can relieve the patient from symptomatic pain, and should include rest, ice, compression and protective strapping or taping. The implementation of a heel raise in the patients’ shoes can also relieve the stress put on the calf muscles during walking.
Examination of the Achilles tendon usually begins with the patient either sitting or in the prone position with legs extending over the end of the examination table. Palpation of the Gastrocnemius-Soleus complex should occur in order to ensure that the area is fully relaxed. Systemic palpation along the Achilles tendon and over the Calcaneus should be used to establish any abnormalities.
The practitioner should then establish the exact site of the pain and compare the degree of swelling with the opposite side. The severity of the swelling is confirmed by passive movements of the foot, which may possibly create a crackling sensation in the Achilles region. This sensation, known as Crepitus, is only present within certain individuals with certain combinations of edema and adhesions.
Flaws in the tendon are usually less distinguishable by touch, but do need to be recorded by the practitioner. In some cases of Achilles tendonitis, the injury may be secondary to small ruptures in the region and needs to be treated carefully. These tears can be difficult to palpate but are usually located at the injured site as a ‘large fusiform swelling’.
Passive extension of the knee while attempting to keep the foot dorsiflexed can be used to test for tightness of the Achilles tendon. A lack of 20-30 degrees of dorsiflexion in extension demonstrates tightness of the Gastrocnemius, and in ability to dorsiflex 30-35 degrees whilst the leg is in flexion means that the Soleus is also causing problems. Manual testing can include attempting resist plantar flexion of the foot, but should also include the patient attempting single leg heel raises. The degree of pain is recorded during all testing.