التهاب تاندون اشیل Achilles tendinitis

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Achilles tendinitis

 

Definition

 

 

Achilles tendinitis is inflammation of the Achilles (uh-KIL-eez) tendon, the band of tissue that connects calf muscles at the back of the lower leg to your heel boneAchilles tendinitis is often a running injury or other sport-related injury resulting from overuse, intense exercise, jumping, or other activities that strain the tendon and calf muscles Most cases of Achilles tendinitis can be treated with persistent, relatively simple, at-home care under your doctor's supervision. Self-care strategies are usually necessary to prevent recurring episodesMore serious cases of Achilles tendinitis can lead to tendon tears (ruptures) and may require surgery to repair damaged tissues

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Symptoms

 

 

 

The most common sign of Achilles tendinitis is pain that develops gradually and worsens over time. Signs and symptoms of Achilles tendinitis include

:

• Mild ache or pain at the back of the leg and above the heel after running or other sports activity
  
• Episodes of more severe pain associated with prolonged running, stair climbing or intense exercise, such as sprinting
  
• Tenderness or stiffness, especially in the morning, that usually improves with mild activity
  
• Mild swelling or a "bump" on your Achilles tendon
  
• A crackling or creaking sound when you touch or move your Achilles tendon
  
• Weakness or sluggishness in your lower leg
  

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Causes

 

Achilles tendinitis, or inflammation of the tendon, is caused by repetitive or intense strain on the tendonYour Achilles tendon is a large band of tissue connecting the muscles in the back of your lower leg to your heel bone. Also called the heel cord, the Achilles tendon is used when you walk, run, jump or push up on your toesA number of factors may contribute to the onset of Achilles tendinitis

:

• A rapid increase in the distance or speed of a running regimen

  
  

• New or intense hill running or stair climbing

  
  

• Sports that require jumps or sudden starts and stops, such as basketball or tennis

  
  

• Exercising without warming up

  
  

• A new, intense exercise regimen after a long period of not exercising regularly

  
  

• Poor flexibility in the calf muscles

  
  

• Running on uneven or hard surfaces

  
  

• Wearing shoes that are worn out or inappropriate for the activity

  
  

• A naturally flat arch, which can put more strain on the Achilles tendon

  
  

• Other slight variations in the foot, ankle or leg anatomy that may put extra strain on the tendon

  
  

• Traumatic injury to the tendon

  
  

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[h=1]Complications[/h]

Achilles tendinitis can progress to a degenerative condition called Achilles tendinosis. This change in the structure of the tendon weakens it and makes it more vulnerable to severe damage. Degeneration of the Achilles tendon can result in a tear, or rupture, which is a painful injury that usually requires surgery to repair the damaged tendon

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Preparing for your appointment

 

 

If you're experiencing pain and other symptoms that may be caused by Achilles tendinitis, you'll likely begin by seeing your family doctor or general practitioner. You may be referred to a doctor specializing in sports medicine or a specialist in disorders of bones, tendons and joints (orthopedist) or a specialist in physical and rehabilitative medicine (physiatrist)

What to expect from your doctor

Be prepared to answer the following questions regarding your symptoms and factors that may be contributing to your condition

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• When did pain or other symptoms begin
  
• ?
  
• Are symptoms worse at certain times of day or after certain activities
  
• ?
  
• Does the pain lessen with rest
  
• ?
  
• What is your normal exercise routine?
  
• ?
  
• Have you recently made changes to your exercise routine, or have you recently started participating in a new sport
  
• ?
  
• What have you done to alleviate pain
  
• ?
  
• What type of shoes do you wear for various activities
  
• ?
  

Questions you can prepare to ask your doctor include the following

:

• What is likely causing the pain
  
• ?
  
• What are my treatment options
  
• ?
  
• How long is recovery likely to take
  
• ?
  
• How much will I need to restrict my current level of activity or change my exercise routine
  
• ?
  
• When do I need to see you for a follow-up appointment
  
• ?
  

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Tests and diagnosis

 

A diagnosis of Achilles tendinitis is based on your answers to questions, results of a physical examination and, if necessary, imaging tests.

Exam

Your doctor will gently touch (palpate) the affected area to determine the location of pain, tenderness or swelling. He or she will also judge the flexibility, alignment, range of motion and reflexes of your foot and ankle.

Imaging tests

Imaging tests can help rule out other causes of symptoms and reveal damage to the tendon. Your doctor may order one or more of the following tests

:

• X-ray, which produces images of hard tissues, can help rule out other causes of symptoms
  
• Ultrasound, an image of soft tissues produced with the use of sound waves, can reveal signs of inflammation and damage to the Achilles tendon. The images can also produce live-action images of the tendon in motion
  
• Magnetic resonance imaging (MRI), which uses a magnetic field and radio waves to produce cross-sectional views or 3-D images, can show details about tissue degeneration and tendon ruptures
  

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Treatments and drugs

 

 

Tendinitis is usually treated with relatively simple interventions, but successful treatment requires patience and careful adherence to treatment guidelines. Your doctor is likely to recommend a combination of interventions for Achilles tendinitis

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• Self-care strategies
  
• Pain medications
  
• Stretching and exercises
  

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Self-care strategies

Self-care includes the following steps, often known by the acronym R.I.C.E

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• Rest. Rest is essential for tissue healing. Depending on the severity of your symptoms, resting may mean not exercising for several days; reducing the duration and intensity of your routine; or switching to an activity that doesn't strain the Achilles tendon, such as swimming. You may need to wear a walking boot and use crutches if you have significant pain when putting weight on your foot. Your doctor can advise you on what type of rest is appropriate for you
  
• Ice. To decrease pain or swelling, apply an ice pack to the tendon for about 15 minutes after exercising or when you experience pain
  
• Compression. Wraps or compressive elastic bandages can help reduce swelling and reduce movement of the tendon
  
• Elevation. Raise the affected foot above the level of your heart to reduce swelling. Sleep with your affected foot elevated at night
  

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Pain medicationYour doctor is likely to recommend a prescription-strength or over-the-counter nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve, others) to reduce inflammation and relieve pain

Long-term use of NSAIDs can cause stomach pain, stomach bleeding, ulcers and other side effects. Talk to your doctor about how long you should take your medication and how he or she will monitor you for side effects

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Stretching and exerciseAppropriate stretching and exercise can promote healing and prevent recurring problems. Your doctor can demonstrate the proper technique or refer you to a physical therapist or specialist in sports medicine. These techniques include

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• Stretching with knees straight. Lean against a wall with your knees straight and heels on the floor to stretch the upper portion of calf muscles
  
• Stretching with knees bent. Place the foot forward and flex the knee and ankle with the heel flat on the floor to stretch the lower portion of calf muscles
  
• Exercising calf muscles. Toe raises or the use of a calf-strengthening machine can help make the tendon stronger and treat Achilles tendon problems. A special type of strengthening called "eccentric" strengthening has been shown to be especially effective in treating chronic tendon problems. An example of this type of exercise to strengthen the calf muscle is slowly descending to the ground after rising on your toes
  

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Other treatmentsAdditional treatments may include the following

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• Orthotic devices protect or change the position of the foot and ankle in order to promote healing. A shoe insert or wedge that slightly elevates your heel can relieve strain on the tendon and provide a cushion that lessens the amount of force exerted on the tendon
  
• Corticosteroid injections may be used with caution to reduce inflammation around a tendon that has been chronically inflamed. An increased risk of tendon rupture has been observed with this treatment. To lower that risk, your doctor may use ultrasound imaging to ensure that he or she injects the corticosteroid near the target site while avoiding a direct injection into the tendon
  
• Platelet rich plasma (PRP) injection is a relatively new treatment under investigation for treating chronic, nonhealing degeneration of the Achilles tendon (Achilles tendinosis) and other chronic tendon problems. This treatment involves injecting your own blood plasma, which contains factors that promote healing, at the site of the inflamed tendon
  
• Surgery to repair damaged tissue and improve function of the tendon is considered only when several months of more conservative treatments don't work or if ongoing inflammation results in partial or complete rupture of the tendon
  

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[h=1]Prevention[/h] While it may not be possible to prevent Achilles tendinitis, you can take measures to reduce your risk

• Increase your activity level gradually. If you're just beginning an exercise regimen, start slowly and gradually increase the duration and intensity of the training
  
• Take it easy. Avoid activities that place excessive stress on your tendons, such as hill running. If you participate in a strenuous activity, warm up first by exercising at a slower pace. If you notice pain during a particular exercise, stop and rest
  
• Choose your shoes carefully. The shoes you wear while exercising should provide adequate cushion for your heel and should have a firm arch support to help reduce the tension in the Achilles tendon. Replace shoes that show excessive wear. If your shoes are in good condition but don't support your feet, try arch supports in both shoes
  
• Stretch daily. Take the time to stretch your calf muscles and Achilles tendon in the morning, before exercise and after exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendinitis
  
• Strengthen your calf muscles. Strong calf muscles enable the calf and Achilles tendon to better handle the stresses they encounter with activity and exercise
  
• Cross-train. Alternate high-impact activities, such as running and jumping, with low-impact activities, such as cycling and swimming