Achilles tenosynovitis is a condition in which there is inflammation and degeneration of the tendon's outer sheath or layer. It is also known as paratenonitis, as the outer covering of the Achilles tendon is called the paratenon. Athletes commonly suffer from this condition and more than half of the achilles tendon injuries occur due to achilles tenosynovitis. This condition usually occurs with tendinosis which is the degeneration of the tendon, although it can occur alone also. As the inflammation starts to heal, there is formation of scar tissue inside the sheath where it connects the inner part of the tendon to the paratenon. Due to this scar tissue formation, the gliding movement of the tendon within the sheath is restricted and this results in decreased range of motion causing pain, tenderness, redness and swelling. Achilles tenosynovitis or paratenonitis is an overuse injury occurring due to repetitive strain over a period of time. It commonly occurs in runners and triathletes due to improper training techniques.
Symptoms of Achilles Tenosynovitis or Paratenonitis
- Pain in the achilles tendon.
- Tenderness to touch.
- Pain upon certain movements such as heel raises or resisted plantar-flexion.
- Pain upon stretching of the achilles tendon.
- Skin is warm to touch.
- Swelling is present posteriorly to the ankle at the region of the tendon.
- A creaking sensation is felt upon ankle movement.
- Fever indicates infection of the tendon or its sheath and needs immediate medical attention.
Causes of Achilles Tenosynovitis or Paratenonitis
- Achilles tenosynovitis or paratenonitis is an overuse injury occurring due to repetitive strain over a period of time. It commonly occurs in runners and triathletes due to improper training techniques and weakness of the tissues. The reasons for this condition are:
- Tight calf muscles and achilles complex.
- An abrupt increase in the training regime.
- Ill-fitting footwear.
- Not stretching properly before and after exercises.
- Lack of proper warm up.
- Calf muscles which are weak or inflexible.
Difference between Tendonitis and Tenosynovitis
Achilles tendonitis is a condition where there is degeneration of the tendon. Achilles tenosynovitis is condition where there is inflammation and degeneration of the sheath surrounding the tendon. The symptoms of both the conditions are very similar and differential diagnosis is extremely difficult. MRI or ultrasound scans help in confirming the diagnosis. In majority of the cases, both these conditions occur together. Treatment for both of these two conditions is more or less the same.
Treatment of Achilles Tenosynovitis or Paratenonitis
- Rest from aggravating activities.
- Ice or cold therapy application to the tendon for 15 minutes every 3-4 hours. This helps in reducing pain, swelling and inflammation.
- After the pain has eased, patient can start doing gentle stretching exercises of the calf muscles.
- Anti-inflammatory medications such as naproxen and ibuprofen help in reducing pain, swelling and inflammation. They can also be used in a gel form.
- Electrotherapy treatments such as ultrasound or laser therapy are also very beneficial.
- Blood Flow Stimulation Therapy (BFST) helps in increasing blood flow to the ankle region and promotes healing.
- After the acute phase has passed, sports massage such as cross frictions can be done by a professional to relax the calf muscles. It also helps in increasing blood flow and in breaking down adhesions.
- After healing is complete, patient should start a rehab program comprising of stretching and strengthening exercises to regain mobility, flexibility and range of motion of the ankle. Calf exercises such as heel drops are very beneficial in achilles injuries.
- If the pain continues then a corticosteroid injection may be given.
Recovery Time for Achilles Tenosynovitis or Paratenonitis?
What all sportsmen suffering from Achilles Tenosynovitis is when he or she get back on the field and perform to the best of his or her capability. To answer this question, the recovery time from Achilles Tenosynovitis or Paratenonitis depends on the severity of the injury and may sometimes take even months to completely heal. Actually, the patient can still be active while carrying the injury. The best way to cope up with Achilles Tenosynovitis or Paratenonitis can be suggested by the therapist and the treating physician. The best exercise by far to get back into shape is swimming which helps tremendously with Achilles Tenosynovitis or Paratenonitis. It is recommended for people suffering from Achilles Tenosynovitis or Paratenonitis to rest and take things easy for a few weeks post injury and not to try to rush back into normal activities until and unless the patient is able to move the injured leg easily and without pain. The injured leg should be as strong as the uninjured leg. There should be no pain felt with jogging, running, or even sprinting. If the patient starts to rush things up and does not follow instructions then it may lead to permanent damage and even disability and potentially saying goodbye to the sporting activity in case of a sportsman.
What are some of the Exercises Suggested for Achilles Tenosynovitis or Paratenonitis?
The following exercises are quite helpful in helping the patients recover from Achilles Tenosynovitis or Paratenonitis.
Toe Stretches: To do this exercise, you need to sit in a chair and extend the injured leg such that the heel of the injured leg touches the floor. Now use the hands to pull the big toe up and back away from the floor. Maintain this position for about 20 seconds. Repeat this exercise about four times. Make sure that this exercise is done about five times a day.
The exercises mentioned below need to be done once the initial phase of Achilles Tenosynovitis injury or Paratenonitis has passed and the pain and inflammation has come down substantially. The patient should begin with gentle stretches and then progress to more advanced exercises.
Calf-Plantar Fascia Stretch Exercise for Achilles Tenosynovitis or Paratenonitis: In this exercise, sit with the legs extended and keeping the knees straight. Take a towel and place it around the injured leg. The towel should be placed such that the towel goes from under the toes. Hold each end of the towel with the hands and try and pull back the towel such that the foot comes towards you. Maintain this position for about half a minute. Repeat this exercise about three or four times a day. Repeat this exercise about five times a day.
Calf Stretch for Achilles Tenosynovitis or Paratenonitis: This is quite an advanced exercise and the patient should make sure that no pain is felt while doing this exercise. To do this exercise, place the hands on a wall. Take a step back with the left leg while keeping it straight and press the left heel hard into the floor. Now, push the hips forward bending the right leg very slightly such that a stretch is felt in the left calf. Now do the same maneuver for the other leg in a similar way. Maintain this position for at least half a minute and repeat this stretch about three times for each leg. Do this exercise about four times a day.
Stair Stretch Exercise to Help Recover from Achilles Tenosynovitis or Paratenonitis: To perform this exercise, you need to stand with the balls of both feet on the edge of a stair all the while holding a solid object with the hands for maintaining balance. Now keep the injured leg straight and let the heel hang gently down th stair until a stretch is felt at the back of the calf. Make sure that some weight of the body should be on the unaffected leg also. Maintain this position for about half a minute and repeat this exercise about five times a day. This exercise can also be done whenever there is tightness felt in the Achilles area.