What are the Signs of Achilles Tendinitis
A patient arrived at the Sydney heel pain clinic describing the signs of Achilles tendinitis in his left ankle. He was 34 years old and was an extremely healthy individual who regularly ran. He had a history of completing Ironman events as well as several marathons and half marathons. He explained to the sports podiatrist that he had never experienced the signs of Achilles tendinitis before and therefore was uncertain about the condition in his feet. The symptoms of Achilles tendinitis developed approximately four months ago and there did not seem to be any apparent reason for the onset of his symptoms. The patient reported to the sports podiatrist that he initially began to feel tightness in his calf muscles and would experience a stiffness through the Achilles tendon first thing in the morning when rising from bed. He would also experience this stiffness and lack of range of motion when walking after being seated for a prolonged period, for example after driving his car. After being seated in the office, the patient would stand up from his chair and would also begin to feel stiffness in his Achilles tendon while walking. These are probably the early signs of Achilles tendinitis, and should be treated immediately. The patient did not stop running but instead continued with his regular exercise program. The majority of the patients runs were on flat surfaces but occasionally involved inclination. Once a week he would include steps and stairs into his running program and this seemed to increase the symptoms of the Achilles tendinitis. Once the patient had began running and his ankle was warmed up, he was able to continue running without too much discomfort and without really feeling the signs of Achilles tendinitis. Therefore, he continued with his training program and did not seek medical advice. After approximately three weeks of discomfort, the patient began to perform on line research. Dr Google provided home remedies in the form of stretching and strengthening exercises as well as foam rolling. The symptoms did not subside and as time progressed signs of Achilles tendinitis increased.
Advanced Signs of Achilles Tendinitis
For this particular patient the early signs of Achilles tendinitis did not subside and his symptoms began to increase. The stiffness turned into sharp stabbing pains and there was significant discomfort when finger and thumb pressure was applied to the sides of the tendon. Each morning upon rising from bed the mild discomfort had turned into significant pain which would cause the patient to hobble to the bathroom. The morning pain lasted longer and did not disappear following his first few steps. Once out on the train on his way to work he would also experience warmth, heat and an awareness through the Achilles tendon. He also experienced another typical sign of Achilles tendinitis which is a visible thickening of the tissue and observable inflammation. At this stage, the patient decided to reduce his running by half, and he inserted more rest days in between his runs. He also excluded the steps and stairs training from his program. However, his symptoms did not subside, and the advanced signs of Achilles tendinitis seemed to be firmly established.
This patient paid a visit to a reputable sports medicine doctor in North Sydney for treatment of his persistent Achilles tendinitis. In addition to some general advice, which is often given to patients with the signs of Achilles tendinitis, the sports medicine Dr offered an injection of cortisone into the Achilles tendon. The patient was rather unhappy about the suggestion and did not want injection therapy. The sports doctor also referred the patient for ultrasound imaging which confirmed thickening of the Achilles tendon, proximal to the heel bone, and inflammatory change consistent with Achilles tendinitis. Fortunately, no tears detected and bursitis was also ruled out.
Other Signs of Achilles Tendinitis
Other signs of more severe and acute Achilles tendinitis involve throbbing sensations and shooting pains when sitting or lying down. This patient did describe to the sports podiatrist on occasions when he was laid down in his bed, the feeling of extreme heat and throbbing sensations through the tendon.
This patient reported to the sports podiatrist that he was disappointed in himself for not acting quickly when he first began to experience the signs of Achilles tendinitis. His condition could have been treated and the advanced symptoms of the condition could have been halted. He explained to the practitioner that he was committed to whatever treatment was on offer as he was desperate to recover quickly and return to his normal training program.
Physical Testing for the Signs of Achilles Tendinitis
The sports podiatrist carried out some physical tests within the clinic to confirm the diagnosis which would tie in with the signs of Achilles tendinitis that the patient presented with. The patient was asked to stand on one leg bearing all of the weight on his troublesome ankle. He was that asked to perform a heel raises with his knee fully extended. The patient was able to perform seven repetitions on his troublesome leg, compared to more than 20 on his stronger leg. This physical test which loads the Achilles tendon is a common test performed when patients present with the signs of Achilles tendinitis, and forms part of the diagnostic process. The practitioner applied lateral pressure using finger and thumb to the Achilles tendon which invoked a significant reaction from the patient. The majority of the pain was along the shaft of the Achilles tendon approximately 3 cm above the heel bone. The patient was also asked to walk on the treadmill in his bare feet while the podiatrist inclined the surface. With the patient walking briskly on the inclined treadmill he reported significant discomfort after approximately two minutes. He was unable to run or sprint on the treadmill due to the pain in the tendon.
As you can see from the descriptions above, there are a variety of signs and symptoms of Achilles tendinitis all of which should be addressed promptly before the condition deteriorates. In summary, the signs of Achilles tendinitis are those such as stiffness, sharp pain, stabbing sensation, throbbing and heat, through the shaft of the tendon, above the heel bone. Some of the symptoms will be present without physical load or pressure on the foot and can cause pain when non-weightbearing. The most obvious sign of Achilles tendinitis is pain with lateral pressure from finger and thumb.
A clear diagnosis was made for this patient and he was booked into the Sydney Heel Pain Clinic for treatment. Please note that the information contained in this article outlines common signs of Achilles tendinitis which should not be taken as medical advice. If you think you have Achilles tendinitis or if you feel like you are developing some of the signs of Achilles tendinitis and you should seek the help of a podiatrist.
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Written by Karl Lockett