Anatomy
The Achilles tendon is the common tendon of the soleus and gastrocnemius muscles. Its primary function is to point your foot downward (plantar flexion) or raise your heel. The Achilles tendon plays a functional role in push-off during your gait cycle, jogging and running.
Etiology
There are two types of Achilles tendonitis:
Insertional Achilles tendonitis is distinguished by a localization of the patient’s symptoms to the insertion point of the tendon into the calcaneus. The signs and symptoms are pain during or after exercise and an erythema to the Achilles.
Non-insertional tendonitis is classified by pain 2-6 cm. above the Achilles tendon insertion. Signs and symptoms include pain after exercise, pain and stiffness is present in the early morning (first steps out of bed). If symptoms persist, pain may become constant. There is also a thickening of the tendon and surrounding swelling.
Achilles tendonitis can further be broken down into two subsets: Paratenonitis and Tendonitis.
- Paratenonitis is when there is a pathologic change to the matrix of the tendon.
- Tendonitis is classified as a damaged paratenonitis; the tendon has now become degenerated. You now have chronic pain, which has been present for at least sixteen weeks.
Risk Factors
- Decreased flexibility of Achilles tendon (Gastrocnemius/Soleus muscles)
- Foot Biomechanics (Forefoot Varus)
- Poor joint Arthrokinematics (Decreased subtalar ROM)
- Footwear
- Decreased Strength
- Decreased endurance of muscle
- Training errors
- Poor treatment of early signs
Evaluation/ Physical Exam
- Point tenderness along Achilles tendon
- Thickening of actual tendon
- Positive crepitus with active movement of ankle along tendon
- Loss of motion in ankle
- Poor flexibility and palpable tightness of gastrocnemius/soleus complex
Treatment Protocol
