Achilles tendinitis is inflammation, irritation, and swelling of the Achilles tendon (the tendon that connects the muscles of the calf to the heel). Achilles tendonitis is also called tendonitis of the heel. Achilles tendonitis is a common overuse injury that tends to occur in middle-age recreational athletes. The overuse causes inflammation that can lead to pain and swelling. Furthermore, Achilles tendonitis can lead to small tears within the tendon, and make it susceptible to rupture. Achilles tendinitis often results from sports that place a lot of stress on your calf muscles and Achilles tendon, such as basketball. It also is often associated with a sudden increase in the intensity or frequency of exercise. So, if you've started on a new exercise kick and you're pushing yourself too quickly, you may be at risk of developing Achilles tendinitis. When treated promptly, Achilles tendinitis is often short-lived. Left untreated, Achilles tendinitis could cause persistent pain or cause the tendon to tear (rupture). If so, you may need surgery to correct the damage. Fortunately, rest and over-the-counter medications to reduce the pain and inflammation may be all the treatment you need for Achilles tendinitis.
Achilles tendonitis is a condition of irritation and inflammation of the large tendon in the back of the ankle. It connects the large calf muscles (Gastrocnemius and Soleus) to the heal bone (calcaneus) and provides the power in the push off phase of the gait cycle. The achilles tendon can become inflamed through overuse as well as a number of contributory factors. The Achilles tendon has a poor blood supply which is why it is slow to heal. Achilles tendoinitis can be acute or chronic. Acute achilles tendinotis may happen as a result of overuse or training too much, too soon especially on hard surfaces or up hills. Treatment may include Cold compression therapy, 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 careful, expert consideration because it can increase the risk of tendon rupture. Severe cases may require surgery from an orthopedic surgeon. High load eccentric contractions have recently been shown to be very effective at decreasing the pain and strengthening the tendon. Prevention includes following appropriate exercise habits and wearing low-heeled shoes. An athletic trainer or physical trainer can prescribe safe exercise methods.
Causes of Achilles Tendonitis
There are many factors such as trauma, overuse, infection and diseases like arthritis that could lead to inflammation of tendon. Overuse is considered as the main common cause behind development of Achilles tendonitis. Tendonitis is common walkers, runners, and athletes who do a lot of jumping and running . Arthritis located around the heel can cause Achilles tendonitis. This occurs because when extra bony growths develop around joints, the tendon can become inflamed and painful.
Symptoms of Achilles Tendonitis
1. Severe pain in the heel when walking or running.
2. Swelling.
3. Warm tendon.
4. Swelling, tenderness and warmth of the Achilles tendon.
5. Redness over the skin.
6. Stiffness that lessens as your tendon warms up.
Treatment of Achilles Tendonitis
The most common treatments are: pain medication, anti-inflammatory medication (aspirin, ibuprofen) and physical therapy. Treatment for an Achilles tendon rupture includes surgery or a cast, splint, brace, walking boot, or other device that will keep your lower leg from moving (immobilization). This gives the Achilles tendon time to heal-generally 6 to 12 weeks. Although treatment for tendinopathy or a rupture takes time, healing is usually successful.
Exercises For Achilles Tendonitis
Tendons consist of collagen (mostly type I collagen) and elastin that sit inside a matrix (framework) with collagen accounting for 65-80% and elastin approximately 1-2% of the mass of the tendon.
Collagen and elastin are produced by special cells called tenoblasts and tenocytes. Crosslinks strengthen the collagen and help them form fibrils which are thin fibers. These fibrils are bunched together to form a collagen fiber which is the basic unit of a tendon. The entire tendon is surrounded by a fine connective tissue sheath called epitenon. The actual structure of a tendon is very complex with fibers being oriented horizontally, longitudinally, and diagonally.
As mentioned above, the basic function of a tendon is to transmit the force created by the muscle to the bone, and, in this way, make joint movement possible. Normally, tendon tissue is extremely tough but it can be damaged through excessive shear forces, trauma, and, recently, with certain drugs.
The Food and Drug Administration recently notified the makers of fluoroquinolone antimicrobial drugs for systemic use of the need to add a boxed warning to the prescribing information about the increased risk of developing tendonitis and tendon rupture. In addition, a Medication Guide for patients was also mandated.
The actual wording of the FDA statement was...
“Fluoroquinolones are associated with an increased risk of tendinitis and tendon rupture. This risk is further increased in those over age 60, in kidney, heart, and lung transplant recipients, and with use of concomitant steroid therapy. Physicians should advise patients, at the first sign of tendon pain, swelling, or inflammation, to stop taking the fluoroquinolone, to avoid exercise and use of the affected area, and to promptly contact their doctor about changing to a non-fluoroquinolone antimicrobial drug.
Tendinitis and tendon rupture most frequently involves the Achilles tendon, and rupture of the Achilles tendon may require surgical repair. Tendinitis and tendon rupture in the rotator cuff (the shoulder), the hand, the biceps, and the thumb have also been reported. Tendon rupture can occur during or after completion of fluoroquinolone use; cases occurring up to several months after completion of therapy have been reported.
Selection of a fluoroquinolone for the treatment or prevention of an infection should be limited to those conditions that are proven or strongly suspected to be caused by bacteria.”
Currently available fluoroquinolone antimicrobial drugs include ciprofloxacin (marketed as Cipro and generic ciprofloxacin), ciprofloxacin extended release (Cipro XR and Proquin XR), gemifloxacin (marketed as Factive), levofloxacin (marketed as Levaquin), moxifloxacin (marketed as Avelox), norfloxacin (marketed as Noroxin), and ofloxacin (marketed as Floxin and generic ofloxacin).
The warnings about fluoroquinolones and adverse effects on tendons applies only to fluoroquinolones for systemic use (e.g., tablets, capsules and injectable formulations); it does not apply to fluoroquinolones for eye or ear use (e.g., eye drops and ear drops).
This danger has been known to be present for approximately 14 years with case reports first surfacing in the 1990's.
One group of investigators have stated, “current exposure to fluoroquinolones increases the risk of Achilles tendon disorders. This finding is in agreement with a smaller study, in which we found an association between tendinitis and fluoroquinolones” (van der Linden PD, et al. BMJ 2002;324:1306-1307).
Researchers feel that the mechanism is due to a toxic effect on collagen fibers. This may be caused by a substance called matrix metalloproteinase.
Bottom line? Avoid these antibiotics if you have any of the above risk factors!
Both Juliet Cohen & Nathan Wei are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.
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