Conquering Achilles Tendonitis In Athletes

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With chronic insertional Achilles tendonitis, you’ll see calcification or spurring at the bone/tendon junction that extends into the tendon.
Here you can see a completed repair of the Achilles tendon rupture, which is covered with  a fanned-out plantaris tendon graft.
Using a heel lift is appropriate for decreasing tension on the Achilles in the acute phase, but the authors recommend phasing the patient out of the lift and into a stretching regimen as soon as possible.
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Author(s): 
By Patrick DeHeer, DPM, and Stephen M. Offutt, DPM, MS

In a survey of professional athletic trainers and team physicians, Achilles tendonitis ranked third behind ankle sprains and plantar fasciitis as the primary presenting complaint within the athletic population.1 Additionally, it accounts for up to 18 percent of all running injuries.2 The condition is highly prevalent among runners, but it is also common in any athlete who endures repetitive high impact microtrauma.3
Regardless of the afflicted population, Achilles tendonitis can severely hamper an athlete’s training and has been the impetus for many athletes to end their careers.
Several factors can precipitate the development of Achilles tendonitis, which is known by numerous other terms including tendinosis, peritendinitis, tenosynovitis, peritendinopathy and Achilles tendinopathy. Overuse can be a cause, especially among the “weekend warrior” athletes.
When it comes to elite athletes, however, biomechanical abnormalities that cause abnormal or prolonged pronation or excessive supination can be an etiological factor. Rheumatic disorders, although they are much less common, can be an underlying etiology. Sudden increases in training, training intensity, changes in training surfaces, changes in shoegear and muscular imbalance can all play a role.3

Ensure A Thorough Anatomical Understanding
In order to provide optimal care, it’s essential to have a thorough knowledge of the associated anatomy of the superficial posterior leg and hindfoot. The gastrocnemius originates as medial and lateral muscle bellies from their respective femoral condyles and courses down the upper half of the leg, transitioning to a wide aponeurosis and ultimately uniting with the soleus to form the tendo Achilles. The soleus takes its origins from the posterior tibia, fibula and interosseous membrane, courses down the leg and ultimately shares its final attachment with the gastrocnemius through the tendo Achilles.

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Anonymoussays: January 13, 2010 at 12:28 pm

I know this is an old article, but hopefully someone reads this. As a physical therapist working with elite athletes and also "weekend warriors," I can tell you that achilles tendinosis/tendinitis is many times due to contralateral pelvis/hip weakness. An example would be a 20 yr old distance runner with L achilles pain who sprained his R ankle two years previous. His R ankle has healed but he developed a compensation pattern of walking and running with inc heel strike and/or push off the L lower extremity. Multiply that by several miles of running and you will eventually get a break down of the L achilles insertion. Until you rehab and correct the contralateral weakness, the problem will likely persist.

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