Achillodynia

synonym

achillodynia

definition

Achillodynia is a pain syndrome in the area of ​​the Achilles tendon, the cause of which is initially unclear, which can occur both at rest and during exertion and which can affect normal physiological movement.

How to properly treat Achilles tendon irritation, read the following article: Achilles Tendon Irritation - How To Treat It Correctly

Occurrence

Achillodynia is one very common disease, especially in the sports medicine and here especially at younger patients.
The most patients are old between 30 and 40 and have at the occurrence already exercised up to 12 years. In the predominant cases are men of the clinical picture affected. The reason is not known. The sport where achillodynia is most common is athletics (78%).

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Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
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Athletes (joggers, soccer players, etc.) are particularly often affected by the Achilles tendonitis disease. In many cases, the cause of the Achilles tendonitis cannot be identified at first. Therefore, the treatment requires a lot of experience. I focus on Achilles tendonitis.

The aim of every treatment is treatment without surgery with a complete recovery of performance.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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• Lumedis - your orthopedic surgeon
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Further information about myself can be found at Dr. Nicolas Gumpert

Causes and forms

In the vast majority of cases, achillodynia is a syndrome that associated with sporting activity is. Mostly are sports affected by those long or monotonous walking work must be carried out. Typical of achillodynia are movement-dependent pain in the area of ​​the Achilles tendon approx. 2-6 cm above the heel.
The causes of achillodynia are usually one degenerative change the Achilles tendon. This becomes clear i.a. by Vascular sprouting and new vascular formations in the area of ​​the Achilles tendon, which documents the degeneration. Inflammatory changes in the Achilles tendon find against it not or only rarely instead of.
Achillodynia is also to be understood as a collective term for various symptoms (see symptoms). In many cases is also the so-called of the degenerative changes Achilles tendon sliding tissue (paratenon) affected.
The differential diagnosis of achillodynia must be Inflammation of the paratenon be seen at it at a motion-dependent crunching of the tendon can come. In this case are often inflammatory changes detectable in the area of ​​the Achilles tendon.
There are numerous Differential diagnoses an achillodynia (see below), which can easily be mistaken for achillodynia.

In principle, one differentiates between primary and secondary achillodynias:

• Secondary achillodynia:
  are in the secondary achillodynia Circumstances or anatomical conditions that lead to increased stress on the Achilles tendon. This additional burden leads to those described above
  Symptoms in terms of achillodynia.
  Factors that put more stress on the Achilles tendon include:
  anatomical shortening, inflammation in the area of ​​the glide and bursa, previous fractures of the upper ankle joint or in the area of ​​the tibia (shin), thickening of the Achilles tendon,
  Calcifications in the area of ​​the Achilles tendon and the sliding structures.
• Primary achillodynia:
  Primary Achillodynia is used when none of the above risk factors are present and the cause of the pain syndrome is unknown.
  The main cause of primary achillodynia will be in a Overloading during sports activities seen. For this reason, the resulting treatment of primary achillodynia is correspondingly limited.

Differential diagnoses

Achillodynia can easily be confused with the following symptoms and diseases (differential diagnoses):

1. Postoperative status after Achilles tendon rupture (see also rehabilitation after an Achilles tendon tearRehabilitation after an Achilles tendon tear)
2. Partial rupture of the Achilles tendon
3. Inflammation of the paratenon
4. Misalignments of the toes, feet or hips with corresponding incorrect loads
5. Bursitis in the area of ​​the Achilles tendon
6. Metabolic disorders (xanthomatosis)
7. Fractures of the ankle joint (see also ankle fractureAnkle fracture)
8. Stress fracture (see also fatigue fracture of the heelFatigue fracture of the heel)

Symptoms

In the early stages of achillodynia, one occurs classic start-up pain at the beginning of the corresponding movement. The Pain are selectively present and become in the area of ​​the Achilles tendon partially also as pulling upwards described. At the pain gradually disappears with prolonged exposure.

• In early stages is found above all Tenderness in the area of ​​the Achilles tendon, regardless of any movements.
• In advanced stages, pain at rest can already occur. The Achilles tendon thickens while running and makes one just by this thickening additional movement-related pain.
  The thickening is then usually palpable. Accompanying the pain it can too Movement impairments come.
• In late stages is almost always one Continuous stress pain available.

You can find a lot more information about the symptoms of achillodynia here.

Those affected describe the Pain mostly as diffuse, so not just limited to a point and from dull to piercing character. The distal portion the tendon, i.e. the part that is located close to the heel, thickened and swollen his and the tendon is no longer displaceable against the underlying tissuewhat would be possible with a healthy tendon.

At a long-lasting achillodynia, in the minor injuries the tendon heal through the formation of scar tissue, the thickening of the tendon can extend up to one Knot formation then even develop feel from the outside can. If the Foot moves achillodynia can sometimes even take the form of a rubbing noise, so called Crepitationsto be heard or the friction to be felt. Furthermore, the Movementsthat are performed with the help of the Achilles tendon in achillodynia only exercised with great difficulty and pain become. The movements affected by this are in particular the Tip toe, the To run and the Leap. These movements come through Contraction of the calf muscles comes about by the resulting Transferring force to the bones of the foot using the Achilles tendon becomes.

But also passive movement of the Achilles tendon, that is, its stretching, leads to achillodynia Pain, for example the Walk on your toes or at Pulling the toes in towards the tip of the nose. Often there is also one in achillodynia Tenderness over the affected tendon. It means that Pain also from external pressure on the tendon can be caused. Furthermore, there is sometimes also one Redness and overheating the skin over the Achilles tendon, which is on one of the Tendon wear following possible inflammation are based.

In contrast to acute damage to the Achilles tendon, in which the pain is so severe within a very short time that the person affected can no longer walk, achillodynia is one degenerative disease. This is where it comes through age-related wear and tear, much more often though in athletes by overload or years of incorrect loading tend to cause minor injuries to the tendon that result in wear and tear. Since usually only one Achilles tendon is affected, achillodynia occurs typically only one-sided on. Rarely can also both tendons be affected by achillodynia.

diagnosis

Since the occurrence of achillodynia one special clientele can be assigned, a precise questioning and investigation is of great importance:

Sick survey:
This should be done specifically after Period of onset of pain be asked, and whether appropriate sports in the form of competitive sport be exercised.
Especially Ball sports, such as athletics are particularly indicative of a corresponding degenerative process.

Physical examination:
First, the Achilles tendon is used relieved leg touched. It comes to one movement-independent tenderness above the calcaneus is from one rather earlier stage to run out of achillodynia. Is the entire Achilles tendon already thickened like a spindle and swollen like a dough (especially after sporting activities) one speaks of a advanced course.
The Examination of worn shoes can point to a Misalignment of the feet and legs give.
The first imaging method is the Ultrasonic applied. It gives various indications of the presence of achillodynia:

• In addition to a thickened Achilles tendon (thicker than 5 mm)
• can be degenerative changes in a side comparison, as well as that
• Presence of fused blood vessels represent and indicate achillodynia.

A X-ray image In most cases, the Achilles tendon can only be displayed if a certain calcification has already started. With the help of the X-ray, however, causes that can lead to secondary achillodynia can be identified or excluded. In addition, a MRI of the Achilles tendon in which the tendon, muscles and bones can be displayed and assessed in parallel. If all diagnostic procedures are unsuccessful, consideration must be given to starting a laboratory test to determine cholesterol and other blood lipids.

Therapy / treatment

In many cases there is one no special treatment necessary and it comes to one Spontaneous healing an achillodynia.
Main way of doing Presence of this degenerative disease is the rapid reduction of the triggering physical stress. The ones leading to the burden sport should quickly reduced or omitted entirely become. Furthermore, a corresponding Shoe insert be chosen and manufactured that the Overloads the Achilles tendon while running counteracts.
The further treatment an achillodynia conservative in all cases. A operative therapy is not mandatory:

• Symptomatic therapy is initiated by immobilizing the leg during an episode of pain.
• Measures that promote blood flow to the tendon should also be taken. This includes stimulation current treatment as well as keeping the foot and heel warm during sporting activities.
• In the exercise-free interval, however, an attempt can be made to reduce the pain by applying cold.
• All orthopedic painkillers are available as medication, but long-term use should be avoided.
• In addition to the non-drug treatments, a well-engineered physiotherapy should also take place, which deals primarily with the incorrect loads and corresponding alternative movements.

The Treatment of achillodynia is in Successful in 70-80% of cases and after the appropriate treatment time, the patients can Resume sports program.

physical therapy

A physical therapy In addition to other options for treating achillodynia, it is an effective method of eliminating the symptoms that occur in the case of achillodynia. Depending on which one stage the Achilles tendon is inflamed different methods in physiotherapy.This should be done with existing pain symptoms and especially when other symptoms such as a Redness or swelling of the tendon occur, gentle forms of therapy are chosen.

In general, the cause of the disease should first be determined so that it can be avoided or eliminated first. Physiotherapy can support the healing process after the elimination of the triggering cause and represent a sensible therapy option. However, it is important that the treating physiotherapist teaches exercises that can also be practiced at home. Particularly by consistently practicing these exercises, even at home, accompanying physiotherapy for achillodynia can be positive for the individual healing process.

Taping / kinesio tape

The therapy of achillodynia using a "Tapes", also Kinesio tape called, should have a beneficial effect on the healing process as well as a Improve stability of the Achilles tendon to reach. Here, the corresponding tape is so on foot and the Lower leg attached so that a stability of the tendon is achieved.

However, it is controversial whether such a therapy with a tape can actually show a scientifically proven effect. The general rule is that treatment with tape should be used if achillodynia is present no harm can cause. It should be noted the appropriate foot first not to burden, even if this were subjectively possible through the tape. This is particularly important for athletes who frequently develop achillodynia. The Risk of aggravation the disease in a continuous load despite the discomfort is very high in these cases and should be avoided. So should be despite the treatment with the tape after the looking for the triggering cause of the disease become. Just by one Elimination of the triggering factor Recurring achillodynia can be prevented for a long time.

You can find much more information about taping at: Taping an achillodynia

Shock wave therapy

Another therapy option at persistent, therapy-resistant achillodynia is the so-called Extracorporeal focused shock wave therapy (EWTS). It is not one of the treatment methods that are reimbursed by health insurance, so it has to be if desired, paid privately by the patient become. The health insurance does not recognize shock wave therapy for the treatment of achillodynia because there is no clear and definitive proof of effectiveness. So far, no scientific study has been able to demonstrate a direct healing effect. However, there is some evidence that extracorporeal shock wave therapy could be helpful in treating achillodynia, which is why there are some doctors who offer this therapy option and recommend it in certain cases.

Shock waves are short pressure wavesthat travel at the speed of sound after being sent out by a small device that remains outside the body. In the orthopedic field, low-energy shock waves are mainly used. These are in contrast to the somewhat better known high-energy shock waves that are used, for example, for minimally invasive gallstone fragmentation. The shock waves propagate in softer tissue - for example water, but also fat, muscles and other soft tissues - without loss of energy; they virtually slide through these structures.

However, the shock waves come in Contact with a hard substance - for example a bone or a hardened, thickened tendon - becomes the Propagation stopped and the energy of the wave discharges. The released energy remains at the point of impact. A healing effect can possibly be achieved through some kind of Stimulation of cells explain by the shock waves. Such a stimulus could stimulate the cells to renew and regenerate themselves. The metabolism of the cells may be activated, which could lead to faster healing.

Nonetheless, many report painful patients over a significant improvement in her symptoms, so that shock wave therapy remains a pleasant therapy option for the patient, since no further imaging is necessary and it can be carried out in an uncomplicated and painless manner. As they in general without great risk there is little in the way of attempting therapy in the case of long-lasting, therapy-resistant symptoms. As already mentioned, however, there is no clear scientific evidence of the effectiveness and the mechanism of action. Even if many patients have very positive experiences, one should therefore beware of miracle healings by private providers and critically question every further (sometimes very expensive) treatment session. Ultimately, it is up to each patient to decide for themselves about the costs of such a therapy and its possible benefits.

bandage

Bandages are similar to treatment in plaster of paris for the treatment of achillodynia, as soon as one Other restraint and restraint are difficult or impossible to implement is. A fixation with bandages in the so-called Equinus position, in which the toe stand is imitated, leads directly after the acute pain event to discharge and thereby relieves pain.

Sports bandages can after Adjustment and explanation by an experienced orthopedist even after an acute achillodynia has healed Stabilization and support be worn to avoid future overload and irritation. Bandages of all kinds therefore always remain an additional component of the treatment concept and are only very rarely used on their own.

Homeopathy for achillodynia

Certain homeopathic medicines will be one positive effect attributed to curing achillodynia. Typical homeopathic remedies that are often recommended for this symptom picture Arnica, Bryona, Rhus toxicodendron or Apis mellifica.

So far, none of these homeopathic drugs has been able to provide scientific proof of effectiveness. For this reason, treatment with homeopathic remedies alone cannot be recommended for achillodynia. Especially when the Symptoms do not subside after a few days or get worse, as well as if Redness, swelling, or warm skin should occur a Doctor for clarification the cause must be sought.

In the course of therapy However, nothing speaks against the simultaneous use of homeopathic remediesif the instructions and therapy plans of the attending physician are observed at the same time. It is important to initially avoid stressing the Achilles tendon in order to prevent the disease from worsening.

course

The course of achillodynia can usually assigned to certain stages become. To Beginningif the tendon wear is not very pronounced, kick Pain only after intense and unusual strain in form of Stinging or Pinching on. The pain usually begins one day after the excessive activity and gradually recedes again in the following days. Because the tendon is at this stage of the disease not yet irrevocably damaged it is very important that Take seriously any pain that occurs during exercise and to save.

If the tendons affected by microtraumas are not spared and healed, their wear and tear continues and consequently the pain occurs even with light to moderate stress on the foot. Though the pain disappears in this stage of the disease, even if you protect your foot accordingly, they kick usually occurs again during sporting activity, because the tendon has already been damaged to such an extent that its complete regeneration can no longer be achieved by sparing it.

Typical at this stage of achillodynia is that the pain mostly at the beginning of the sporting activity occurs from quiet situations, such as in the morning after getting up, what is known as what is called Starting pain designated. It is also typical that the The pain improved again after this initial exercise will and afterwards often painless can continue training. If the tendon continues to wear out, the pain is no longer limited to sporting activity, but pedaling even with everyday movements like that normal running on what a high level of suffering and a enormous reduction in quality of life caused. Finally can a Persistent pain result, which is constantly present even at rest.

Duration

The duration of achillodynia depends crucially on the nature of the course of the disease; depending on whether you are dealing with a acute or chronic achillodynia has to do, one can count on a few days or even several years. However, if you pay attention to important warning signals from the body at an early stage, a protracted chronic course can almost always be avoided and after a few days of rest and cooling, the symptoms will disappear again.

The healing process is more complicated particularly strong expression the clinical picture and / or one pre-existing chronification. The time it takes to develop achillodynia also varies greatly from patient to patient. Some run marathon distances without ever feeling any symptoms of overload, while others are plagued by pain after an easy 5 km run. This is where the personal anatomical situation and disposition, but also the training and especially the stretch condition play an important role.

Prophylaxis through stretching exercises

As the most common cause of achillodynia the Overloading the Achilles tendon it is essential that this tendon is straight prepare well for exerciseto warm up and then the Stretch achilles tendon. Good stretching exercises for the Achilles tendon mimic the opposite of what the tendon actually does. While the Achilles tendon usually pulls the forefoot down hard (basically making us stand on tiptoe), the optimal stretch is the Pull the forefoot up with the tips of your toes.

The most powerful variant of this stretch encompasses the entire back of the leg muscles: You do one while standing The foot is raised a little on a step or a stool and pulls the Toes towards the body approach. Depending on the degree of stretching, the hand can grip the toes and increase the pull towards the body even further.
Even with the help of a Stair step the Achilles' eyes can be stretched excellently: For this, one foot is completely on the step, while the heel of the other protrudes over the step. This heel can now carefully pushed down with the help of your own body weight become. The other leg serves as a supporting leg and bears the main weight.

Especially unstretched ones should, however In the beginning it is better to stretch more slowly and carefully, otherwise there is a risk of muscle or tendon tears and painful overstretching.

Summary

Achillodynia is a very common disease that especially younger athletes concerns. The reason is mostly degenerative change in and around the Achilles tendon with associated moderate to severe pain, especially when moving.
A distinction is made between primary and secondary courses:

• The secondary forms include diseases that change the environment or the anatomy in the area of ​​the Achilles tendon and thus lead to increased friction. These include situations after an operation, inflammation of the bursa, injuries to the joints and Fractures of the ankle joint.
• The primary form is mostly degenerative in nature.

Inflammatory changes are more likely to speak against achillodynia.

Stage-dependent symptoms can be found:

• in the Initial stage the patient usually feels one Starting painwho, however with prolonged movement again regresses.
  Achillodynia is also in the early stages Pressure pain in the Achilles tendon area.
• In advanced stage it comes to Persistent pain and Resting pain.
  Furthermore the Achilles tendon swells edematous (swelling with water retention) on and can be felt as a thickened area above the heel bone.

The patient is first asked diagnostically about the occurrence, time and type of sport practiced. The Achilles tendon is then palpated. Ultrasound is performed as an imaging diagnosis, in which degenerative changes and vascular sprouting in the area of ​​the Achilles tendon can be made visible.

A X-ray The Achilles tendon usually only shows when it heavily calcified is. However, degenerative changes can occur in the area around the Achilles tendon as well Fractures are excluded.
In rare cases a Magnetic resonance imaging be carried out in the Muscle, tendon and bones shown in more detail can be.
Achillodynia becomes treated only conservatively. First, the exercise of the triggering sport should be restricted. The footwear should be checked and, if necessary, provided with shoe insoles. Furthermore, the blood supply should be ensured by keeping the foot warm.
The conservative therapy is rounded off by physiotherapy with electrical stimulation and cold applications. The success rate is 70-80%.