Achilles Tendinitis

Achilles tendinitis is a common condition that occurs when the large tendon that runs down the back of the lower leg becomes irritated and inflamed.
Achilles tendinitis pain can occur within the tendon itself or at the point where it attaches to the heel bone, called the Achilles tendon insertion

💫Causes 💫
1⃣ sudden increase in the amount or intensity of exercise activity. For example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance may cause irritation and inflammation.
2⃣ Tight calf muscles. Calf muscle tightness puts extra stress on the Achilles tendon, especially where it inserts into the heel bone.
3⃣ Haglund’s deformity. This is a condition in which there is enlargement of the bone on the back of the heel. This can rub on the Achilles tendon and cause inflammation and pain.

🚥🚦symptoms of include🚦🚥

°Pain and stiffness along the Achilles tendon in the morning
°Pain along the tendon or back of the heel that worsens with activity
°Severe pain the day after exercising
°Thickening of the tendon
°Bone spur formation (insertional tendinitis)
°Swelling that is present all the time and gets worse throughout the day or with activity
°Pain on the back of the heal when you wear shoes

⭕Diagnosis include:⭕

X-rays, which provide images of foot and leg bones
MRI scans, which can detect ruptures and tissue degeneration
Ultrasounds, which can show tendon movement, related damage, and inflammation

⛔The Thompson test examines the integrity of the Achilles tendon by squeezing the calf. It is performed as a clinical test to identify the presence of a complete Achilles rupture.

⛔The Matles test assesses the Achilles tendon for suspected rupture. Ask the patient to lie prone with her knees flexed to 90 degrees with the feet relaxed. In a normal test, her feet will be in slight plantarflexion. Dorsiflexion of the foot is a positive test, and indicates a ruptured Achilles tendon on that side.
⛔Royal London Hospital test
Once local tenderness had been elicited palpating the tendon with the knee extended, the tender portion of the tendon was palpated again with the knee flexed to 90°. The test was considered positive if the pain was markedly reduced or absent in knee flexion
Made and Composed by Dr Hashim Raees Khan Raees Physiotherapy and Rehab Clinic Taunsa

💠🔹💠Physical therapy intervention💠🔹💠

🔹RICE protocol

🔶Towel Stretch
Sit on a hard surface with your injured leg stretched out in front of you. Loop a towel around the ball of your foot and pull the towel toward your body, keeping your knee straight. Hold this position for 30 seconds and repeat 3 times.

🔶Standing calf stretch:
Facing a wall, put your hands against the wall at about eye level. Keep the injured leg back, the uninjured leg forward, and the heel of your injured leg on the floor. Turn your injured foot slightly inward (as if you were pigeon-toed) as you slowly lean into the wall until you feel a stretch in the back of your calf. Hold for 30 seconds. Do this several times a day.

🔶. Plantar fascia stretch:
Standing with the ball of your injured foot on a stair and slightly toed out, reach for the bottom of the step with your heel until you feel a stretch in the arch of your foot. Hold this position for 30 seconds. Relax and then repeat 3 times.

🔶Toe raises:
Stand in a normal weight-bearing position. Rock back on your heels so that your toes come off the ground. Hold this position for 5 seconds. Repeat 10 times. Do 3 sets of 10.

🔶Heel raises:
Standing, balance yourself on both feet behind a chair. Rise up on your toes, hold for 5 seconds and then lower yourself down. Repeat 10 times. Do 3 sets of 10.

🔶Single leg balance:

Stand without any support and attempt to balance on your injured leg. Begin with your eyes open and then try to perform the exercise with your eyes closed. Hold the single-leg position for 30 seconds. Repeat 3 times.

🔶Toe stretch

Sit in a chair, and extend your affected leg so that your heel is on the floor.
With your hand, reach down and pull your big toe up and back. Pull toward your ankle and away from the floor.
Hold the position for at least 15 to 30 seconds.
Repeat 2 to 4 times a session, several times a day

🔶Side-lying leg lift:
Lie on your uninjured side. Tighten the front thigh muscles on your injured leg and lift that leg 8 to 10 inches (20 to 25 centimeters) away from the other leg. Keep the leg straight and lower it slowly. Do 2 sets of 15.

Stand with the foot of your injured leg on a support 3 to 5 inches (8 to 13 centimeters) high –like a small step or block of wood. Keep your other foot flat on the floor. Shift your weight onto the injured leg on the support. Straighten your injured leg as the other leg comes off the floor. Return to the starting position by bending your injured leg and slowly lowering your uninjured leg back to the floor. Do 2 sets of 15.

🔶Gastrocnemius Stretch

Stand facing a wall with your feet hip-width apart and staggered, with your hurting foot in the back.
Bend your front knee while keeping the heel of your back foot on the ground and your knee straight.Lean into the wall until you can feel a low to moderate-intensity stretch in the calf of your back leg.Hold the pose for 30 seconds. Repeat three to five times. You can do the stretch several times each day.

🔶Soleus Stretch

Face a wall and stagger your feet, keeping your hurting leg in the back.
With the heel of your back foot on the ground, slightly bend the knee of your painful leg.
Shift your body weight toward the wall without lifting your hurting heel off the ground. Stop when you feel a stretch in the lower portion of your calf.Stay in the position for 30 seconds before relaxing. Try three to five repetitions at a time and repeat this stretch twice a day

🔶Balance and reach exercises:

Stand next to a chair with your injured leg farther from the chair. The chair will provide support if you need it. Stand on the foot of your injured leg and bend your knee slightly.
With the hand that is farther away from the chair, reach forward in front of you by bending at the waist. Avoid bending your knee any more as you do this. Repeat this 15 times. To make the exercise more challenging, reach farther in front of you. Do 2 sets of 15.
Reach the hand that is farther away from the chair across your body toward the chair. The farther you reach, the more challenging the exercise. Do 2 sets of 15.


🔲Extracorporeal Shockwave Therapy (ESWT)
This therapy uses either low- or high-energy shockwaves applied to the Achilles tendon to promote healing of the damaged tendon tissue.

High-energy ESWT can be done in one visit but requires local or general anesthesia.
Low-energy ESWT consists of 3 to 4 sessions and does not require local anesthesia.

There is a small amount of evidence to support the application of iontophoresis using dexamethasone in the acute stage but not in the chronic stage

🔲TENS to reduce pain

🔲K Tapping
Clinicians may use rigid taping to decrease strain on the Achilles tendon and/or alter foot posture in patients with Achilles tendinopathy

🔲Dry Needling
Clinicians may use combined therapy of dry needling with an injection under ultrasound guidance and eccentric exercise to decrease pain for individuals with symptoms greater than 3 months and increased tendon thickness


🔲Heating pad to ease symptoms

⚜🧦Night Splinting🧦⚜
Night splinting can provide significant relief for morning pain when you first get out of bed. These removable braces work by holding your foot in place with your toes pointing upward (similar to the calf stretch position) while you sleep. This helps to maintain calf flexibility and decrease the pull of your Achilles tendon on your heel

💉Sclerosering Injections
💉Corticosteroid injection
💊Anti-Inflammatory drugs

⭐Wear shoes with proper cushioning and arch support. Make sure the heel is slightly elevated to take tension off your Achilles tendon. If you’ve worn a pair of shoes for a long time, consider replacing them or using arch supports.
👞👠Reduce the heel size of shoes gradually when transitioning from high heels to flats. This allows your tendon to slowly stretch and increase its range of motion.
☘Exercise on flat, even surfaces.
☘Be extra careful exercising if you’re taking fluoroquinolone.
☘Stop doing activities that cause pain…..