MANUAL MINORS
Achilles tendonitis is the inflammation of the tendon that connects the calf muscles to the heel. This condition usually arises from overuse or repetitive microtrauma and is common among runners, athletes, or individuals engaging in intense physical activities.
Paratendinitis, on the other hand, refers to inflammation of the sheath surrounding the tendon (paratenon), and it often occurs alongside tendonitis. Both conditions cause pain, swelling, and stiffness in the back of the leg, worsening with physical activity.
Diagnosis
Diagnosis is based on a clinical history of progressive pain in the back of the leg that worsens with physical activity. Physical examination may reveal localised pain, tenderness along the tendon, and thickening or crepitus in the case of paratendinitis. Imaging tests such as ultrasound or magnetic resonance imaging (MRI) can confirm tendon and paratenon inflammation and rule out tears or ruptures.
Differential Diagnosis
Condition | Key Differentiation |
|---|---|
Achilles tendon rupture | Sudden sharp pain with a “snap,” followed by an inability to walk or stand on tiptoes. |
Retrocalcaneal bursitis | Localised pain at the back of the heel, with visible swelling over the bursa, without direct tendon involvement. |
Plantar fasciitis | Pain in the bottom of the heel, worsened by walking or standing in the morning. |
Gastrocnemius muscle tear | Sharp pain in the calf after exertion, often with a “snap,” but without involvement of the Achilles tendon. |
Iliotibial band syndrome | Pain on the lateral side of the leg, without involvement of the Achilles tendon or calf. |
Emergency Management
Initial management of Achilles tendonitis and paratendinitis focuses on reducing inflammation and preventing further damage. Treatment includes rest, ice application to reduce inflammation, and light compression to control swelling. Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) are administered for pain relief.
It is important to avoid activities that exacerbate the condition, such as running or jumping, and referral to physiotherapy for an appropriate rehabilitation plan is recommended.
Definitive Treatment
Definitive treatment consists of conservative measures such as:
Rest and activity modification: Limiting activities that involve running or jumping to allow the tendon to heal.
Physiotherapy: Strengthening and progressive stretching programmes for the Achilles tendon and calf muscles to reduce tendon stress.
Orthotics or heel lifts: The use of orthopaedic devices that slightly elevate the heel can reduce strain on the Achilles tendon.
Injections: Corticosteroid injections are generally discouraged directly into the Achilles tendon due to the risk of rupture but may be used for severe paratenon inflammation under medical supervision.
In chronic or treatment-resistant cases, surgery may be considered to remove inflamed or degenerated tissue and repair the damaged tendon. Postoperative rehabilitation is essential to restore function and prevent recurrence.
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