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Chondromalacia Patella | Plantar Fasciitis | Achilles Tendonitis | Shin Splint | Morton's Neuroma | Ilio Tibial Band Syndrome

What is it?

Achilles tendonitis is a condition wherein the Achilles tendon, at or near its insertion to the posterior aspect of the calcaneus, becomes inflamed and causes pain.

The Achilles tendon is one of the longest and strongest tendons in the body. It is avascular and therefore slow to heal. The Achilles tendon is formed in the lower third of the posterior aspect of the tibia. Two muscles join to form the Achilles Tendon: The Gastrocnemius which originates on the posterior aspect of the femur, and the Soleus which originates on the posterior aspect of the upper third of the tibia. The Achilles tendon is an anti-pronator.

What are the common symptoms/complaints?

Patients complain of severe pain felt in the back of the ankle

How is it caused?

Overstress of the tendon. During a normal gait cycle, the femur and the tibia rotate in unison (i.e. internally during pronation and externally during supination). However, when a person over-pronates, the tibia is locked into the talus by the saddle joint and therefore continues to rotate internally past the end of the contact phase while the femur receives its orders from the brain and begins to rotate externally at the beginning of midstance. The resulting counter rotation of the femur and the tibia causes a shearing force to occur in the achilles tendon because the Gastrocnemius muscle is attached to the femur and rotating externally while the Soleus muscle is attached to the tibia and fibula and rotating internally during over-pronation. This shearing force twists the tendon at its weakest area, namely the achilles tendon itself, and causes the inflammation. Since the tendon is avascular, once inflammation sets in, it tends to be chronic.

How is it treated?

Since the problem is the over-pronation, the patient should be fitted with orthotics. Tightness in the tendon itself can be helped by an extra heel lift added to the orthotics. The patient can expect a slow recovery over a period of months.