achillodynia

Achillodynia: description

The Achillodynie (“dynia” = pain) describes a painful condition of the Achilles tendon, which usually occurs after an unusually heavy load. The complaints usually resolve after a few days of protection alone. However, they can occur again at any time after renewed use. Achillodynia is not the result of an acute injury to the Achilles tendon, but Result of many years of faulty or overloading, Over the course of a few years, the Achilles tendon is progressively structurally damaged (“degenerative changes”).

Achillodynia is one of the most common sports injuries and affects above all professional athletes. Amateur athletes can also suffer from it. Especially sports with high running and jumping load are typical triggers for achillodynia. Doctors assume that about ten percent of all joggers know this state of pain. Overall, more men than women suffer from the Achilles tendon. In about 40 percent of cases, those affected have a bilateral achillodynia. An occurrence of the disease without physical stress is extremely rare.

Mostly, the Achillodynie begins around the age of 30 years. Patients have been doing sports for an average of twelve years. It is reported in cases in which the Achillodynie already occurred after four years of training time. Other patients do not become ill until 20 years after starting the training.

Anatomy and physiology of the Achilles tendon

The Achilles tendon is the thickest and strongest tendon of the human body. It is the common tendon of the three-headed calf muscle (Musculus triceps surae), which attaches to the heel bone. The Achilles tendon transmits the force of the calf muscle to the foot. If the calf muscle contracts (muscle contraction), the foot on the toes is lowered. This is necessary, for example, when tiptoeing, while running or jumping. In Achillodynie these movements are often difficult or painful. Also, movements in which the Achilles tendon is stretched passively, such as lifting the toes when going uphill, are painful.

The Achilles tendon can withstand high loads. Nevertheless, she is also often affected by injuries. The blood supply is poor in some areas of the Achilles tendon, which is why damage to the Achilles tendon does not always heal completely. After a few years, achillodynia or a tear of the Achilles tendon may result.

Achillodynia: symptoms

The Achillodynie manifests itself by load-dependent pain of the Achilles tendon. When it hurts depends on the extent of the injury: At an early stage of the Achillodynie patients complain only after an unusually heavy use of pain. Most of the pain occurs about a day after the load and sound off in the following days by itself.

Other typical aches and pains in Achillodynia:

• The pain can occur both during active movement of the foot (toe-to-toe) and during passive stretching of the Achilles tendon (minced meatus).
• The Achilles tendon hurts when pressed on, and may already be thickened.
• The skin over the tendon may be reddened and overheated due to the inflammatory irritation.
• Swelling in the area of ​​the Achilles tendon is possible.
• In some cases the Achilles tendon crunches audibly when the foot is moved (crepitation sign).
• The complaints are mainly one-sided. However, both sides can be affected at the same time.

Advanced Achillodynia
As achillodynia progresses, the pain is already noticeable during or just after a moderate strain. The Achilles tendon is now somewhat thickened in response to the ongoing overload. Although the pain disappears, if you spare yourself, but they come back when re-stress. Some sufferers complain especially when warming up in pain. Often, at this stage, the suffering is already great, because sporting activities are possible only in pain.

In case of advanced achillodynia, the structural damage to the Achilles tendon is so great that it can develop a permanent pain in the back. At this stage, everyday stresses such as walking are very painful. The quality of life is often severely limited. Complete regeneration of the severely damaged tendon is hardly possible at this stage.

Achillodynia: causes and risk factors

The Achillodynie arises mainly due to a Fehlbelastung or overloading the Achilles tendon during sports. This is often the case with professional athletes, but also recreational athletes may be affected, especially runners. But also football and tennis players, triathletes or ballet dancers have more problems with achillodynia. Because especially fast running and jumping movements lead to an increasing wear of the Achilles tendon. Doctors refer to this wear as a “degenerative change”. It arises mainly in the lower part of the Achilles tendon near the tendon insertion on the heel. There, the blood supply to the Achilles tendon is usually poor, which is why injuries do not heal so well.

Exposure to the Achilles tendon is constantly causing tiny damage (microtrauma) within the tendon. Regular overstressing of the tendon creates a mismatch between the many small microtraumas on the one hand and the Achilles tendon’s limited ability to regenerate on the other hand. However, it is very different how fast an achillodynia develops in an individual case. This is influenced by several factors:

External factors

• Training State: The worse the general physical training state, the less stressful the tendons of the body are in general.
• Type of load: Especially running and jumping cause damage to the Achilles tendon.
• Frequency and duration of the load
• Intensity of the load
• Regeneration breaks: Athletes who do not regenerate adequately have a higher risk of degenerative changes to the Achilles tendon.
• Wrong footwear during sports: Inappropriate footwear can lead to a bad foot load, which burdens the Achilles tendon excessively.
• Wrong footwear in everyday life: If women wear high heels over a long period of time, the Achilles tendon may shorten and cause achillodynia.
• Cortisone therapy: Cortisone can damage the connective tissue and thus the tendons.

Internal factors

• Age: The older a person is, the lower is usually the ability to regenerate.
• Weight: Obesity leads to a permanent overload of all tendons and joints in the body.
• foot deformities: For example, a Senkfuß or a ligament weakness in the upper ankle stress the Achilles tendon excessively.
• Metabolic diseases: High blood uric acid and lipid levels can damage tendons, such as gout.

Achillodynia: examinations and diagnosis

The right contact person for suspected achillodynia is a specialist in orthopedics. At the doctor’s appointment, the doctor will first ask you questions about the current complaints and possible previous illnesses or operations (anamnesis). These can be, for example:

• Where exactly is the pain?
• When will the pain occur?
• Is there something that relieves the pain?
• How often do you do sports?
• Which sport do you practice?

In addition, you will be physically examined. In order for an Achillodynie can be determined, you have to lie down on the stomach. Then the doctor takes your Achilles tendon between two fingers. This “forceps grip” can hurt people with achillodynia. In addition, the doctor feels whether the Achilles tendon is thickened or swollen. In addition, the physician will move his foot and ask you if necessary to walk on your toes and hoe. In order to differentiate the Achillodynie from other diseases of the Achilles tendon, more imaging studies are usually necessary.

Further investigations

Partial tearing of the Achilles tendon, inflammation of the tendon sheath, or heel spur can cause similar discomfort and must be differentiated from achillodynia. This is possible with imaging techniques such as magnetic resonance imaging (MRI, “nuclear spin”), ultrasound and possibly X-rays. An MRI is nowadays the first choice. In particular, deep layers of the Achilles tendon can be shown, which are often affected in the Achillodynie. The ultrasound is used to exclude a tendon tear and is often used to document the course of the disease. The x-ray shows possible calcifications of the Achilles tendon and bony injuries of the foot.

Achillodynia: treatment

Achillodynia therapy is usually purely conservative, not surgical. Only if this Achillodynie treatment does not succeed, an operation is necessary in rare cases.

In the conservative achillodynia therapy the relief of the Achilles tendon is especially in acute complaints in the foreground. To do this, you must first expose the triggering load (for example, jogging) and protect the foot as well as possible. He may only be fully recovered when the pain has completely subsided. In addition will be Painkiller such as paracetamol, ibuprofen or diclofenac. If the pain occurs immediately after exercise, it helps to cool the Achilles tendon. If the disease is completely gone after several days, the tendon should be warmed to promote the healing process. Likewise, special inserts for footwear help with achillodynia. Exercises that you learn in physiotherapy will show you how to straighten your foot in the right way. There is also the possibility to install kinesiological tapes. Some doctors also recommend injecting substances such as glucose or “Actovegin” to the tendon to accelerate wound healing. The effectiveness of these syringes, however, has not been scientifically proven.

At a surgical achillodynia treatment either the tendon skin (peritendinum) is split or parts of the altered tissue are removed (debridement). Surgery is useful as a measure only if conservative therapy has not struck for a long time. The patient must be aware that the symptoms of achillodynia may persist even after surgery. In addition, surgical treatment involves the risk of scarring in the tendon, which can also cause pain. If necessary, the tendon may tear more easily after surgery.

Achillodynia: disease course and prognosis

Sport is generally the most important risk factor for the development of achillodynia. However, achillodynia is not necessarily the result of any physical activity. Affected parties therefore do not necessarily have to do without sport. The way it is operated has a major impact on the disease process and prognosis of the disease.

Basically every athlete should be careful enough rest breaks between the individual training sessions. It is also important that you feel the burden warms up and while exercising, be mindful of the body as possible not to overload, Already these three simple basic rules can help to minimize damage to the Achilles tendon and promote regeneration.

In addition, during the training and also in everyday life on the right footwear be respected. Get advice from an orthopedic shoemaker in a specialist shop and with foot deformities. Women should be careful not to wear high heels too often or too long. This can lead to tendon shortening and then achillodynia without any physical activity. Especially when the ladies start to jog and start wearing everyday high heels, they have a significantly higher risk of developing achillodynia.

Achillodynia often disappears when the load is removed. If you give the Achilles tendon time to relax and consistently omit the triggering sport or the wrong footwear until it is completely free of pain, you can achieve freedom from pain. However, the Achilles tendon may sometimes be so damaged in advanced achillodynia that persistently pain during exercise or at rest. If sufferers take their complaints seriously at an early stage and follow the tips mentioned above, one can achillodynia prevent in many cases.