What Is The Achilles Tendon?
The largest and strongest tendon in the body is the Achilles tendon. Also called the Calcaneal tendon, it is a band of fibrous tissue that connects the heel bone (calcaneum) to the calf muscles. The Achilles tendon helps in the movement called plantar flexion, which is the bending of your foot downwards at the ankle. This happens when the calf muscles flex. The Achilles tendon pulls on the heel and allows us to stand on our toes when jumping, walking, or running.
The Achilles tendon is prone to injury because of the high tensions placed on it and limited blood supply. Problems in this tendon affect the back of the lower leg. This might also affect your ability to walk properly.
What Is Achilles Tendinopathy?
Repeated microtrauma or tiny injuries to the Achilles tendon can lead to a condition called Achilles Tendinopathy. Over time, when the tendon does not heal completely after injury, the damage builds up and leads to this condition.
The tiny injuries can be due to overuse of the Achilles tendon, training on very hard surfaces, not wearing appropriate footwear for training, following poor training techniques, and making sudden changes in the training schedule. If not taken care of, it can lead to a sudden injury or severe rupture of the Achilles tendon.
This condition can affect both athletes and non-athletes. People who take part in sports that involve running or jumping, like football, tennis, badminton, and dancing, are at a higher risk if they don’t train properly.
Signs and Symptoms of Achilles Tendinopathy
- Pain and stiffness are the major symptoms of Achilles tendinopathy. Stiffness develops gradually and is usually worse in the morning when you wake up.
- The tendon may be very tender to touch, and there may be a lump, or you can hear a clicking sound when you move your ankle.
- Pain varies from person to person. Pain is at its worst after exercise generally. Some people may experience pain during exercise also. This pain may prevent you from doing physical activity normally.
- There may be some swelling around the area.
- Severe pain and difficulty walking may be because of a rupture. You need to talk to a doctor immediately to treat it.
How Does Genetics Influence Achilles Tendinopathy?
Several studies have documented the influence of genetics on this condition. Variations in genes like MMP3, TNC, TIMP2 can increase your risk of this condition.
MMP3 Gene
This gene encodes a protein belonging to the matrix metalloproteinase(MMP) family. Proteins of this family are involved in the breakdown of the extracellular matrix, which is present in the space between cells in various processes as well as disease conditions.
rs679620
rs679620 is an SNP found in the MMP3 gene. The GG genotype is found to be associated with Achilles Tendinopathy. Athletes with the G allele are found to have an increased risk of chronic Achilles tendinopathy.
TIMP2 Gene
This gene encodes a protein called tissue inhibitor of metalloproteinases 2. These proteins inhibit the activity of metalloproteinases and also prevent the proliferation of certain cells.
rs4789932
rs4789932 is an SNP found in the TIMP2 gene. Athletes with C allele are found to have an increased risk of chronic Achilles tendinopathy.
Non-Genetic Factors That Influence Achilles Tendinopathy
Gender: Achilles tendinopathy is more common in men probably because of stiffer tendons.
Health conditions: People with certain types of arthritis are more prone to Achilles tendinopathy. It is also common in people with high blood pressure, high cholesterol, or diabetes.
Medication: Fluoroquinolones are a class of antibiotics used against certain bacterial infections and are most commonly used to treat Urinary Tract Infections. People taking these medications are found to have a higher risk of developing Achilles tendinopathy.
Age: This condition is more common in people above 30 years of age.
Diagnosing Achilles Tendinopathy
Your doctor or physiotherapist can usually diagnose this condition through physical examination. They might prescribe certain tests to rule about underlying health conditions that may be the cause. If the diagnosis is not clear with a physical examination, an ultrasound or MRI is taken.
What Can You Do To Prevent and Manage Achilles Tendinopathy?
Rest: A break from physical activity and sports that strain the Achilles tendon is recommended. You can start again once the pain becomes better. Talk to your doctor to devise a plan.
Pain-killers: Your doctor may prescribe certain pain-killers like paracetamol or ibuprofen to relieve the pain temporarily.
Ice treatment: Ice-packs are useful to reduce pain and minimize swelling.
Exercises: Certain exercises can help stretch and strengthen the Achilles tendon. A physiotherapist can help you devise a suitable exercise plan.
Orthotics: A change in footwear or specialized footwear may be recommended by a specialist to relieve pain.
Specialized treatment: Various treatments are being researched to find the best way to treat this condition. These treatments include shock-wave therapy, which uses special sound waves, and autologous blood injection, which is the injection of your blood in the area around the Achilles tendon. The use of this treatment and side-effects should be discussed with your doctor before going ahead.
Surgery: In very severe cases, if all other treatment options fail, surgery is recommended.
Summary
- Achilles tendinopathy is caused by repeated microtrauma or tiny injuries to the Achilles tendon. This condition is common in people who take part in sports that involve running or jumping like football, tennis, badminton, and dancing are at a higher risk if they don’t train properly.
- Stiffness of the tendon, especially in the morning, is a common symptom of this condition. Pain, swelling, and tenderness in the area surrounding the Achilles tendon are also common symptoms.
- The G allele of SNP rs679620 found in the MMP3 gene and the C allele of SNP rs4789932 found in the TIMP2 gene increases the risk of chronic Achilles tendinopathy.
- Certain health conditions like arthritis and medicines that include fluoroquinolones increase the risk of this condition. People above 30 years of age and males are more prone to this condition.
- Rest, use of pain-killers and ice packs are recommended to manage this condition. Specialized footwear may also be used. The effectiveness of various treatments is being studied. Surgery is recommended for severe cases when all other treatments fail.
References
https://www.webmd.com/fitness-exercise/picture-of-the-achilles-tendon#1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079614/
https://www.physio-pedia.com/Achilles_Tendinopathy#cite_note-1
https://pubmed.ncbi.nlm.nih.gov/19042922/
