DEAR DOCTOR K:

I have Achilles tendinitis. What can I do to ease the pain in my foot?

DEAR READER:

Your Achilles tendon -- a rope of sturdy tissue that connects muscle to bone -- runs up the back of your heel. Achilles tendinitis occurs when the tendon becomes inflamed. This causes pain and sometimes tenderness and swelling in the back of the heel.

The pain is often described as a burning sensation. It's worse during any activity that stresses the tendon, like walking or running. (I've put an illustration showing where Achilles tendinitis occurs on my website, AskDoctorK.com.)

A related problem is Achilles tendinosis. It occurs when the tendon degrades -- much like a rope fraying. The symptoms and treatment of Achilles tendinitis and tendinosis are very similar.

Achilles tendinitis usually results from overuse or exertion while running, especially up and down hills. It often begins following a period of increased training. It is more likely to occur in people who are overweight, and during training outdoors in winter. I'm not sure why it's more likely to occur in winter; it could be that cold temperatures make the Achilles tendon stiffer and more easily injured.

Swelling and stiffness can worsen with exercise. To prevent this, do warm-up stretches before you exercise. Poorly fitting shoes may also contribute, so make sure your shoes fit properly.

An ultrasound test can show the inflamed area around the tendon, but such a test usually is not necessary: The symptoms and physical examination by a doctor make the diagnosis clear.

Treatment of Achilles tendinitis and Achilles tendinosis involves a regimen called RICE: Rest, Ice, Compression and Elevation. RICE helps limit pain and additional damage:

-- Rest: Reduce your activity and sit or lie down.
-- Ice: To reduce inflammation, apply ice to the injury.
-- Compression: Wrap an elastic compression bandage around the injured area to provide support and reduce swelling. Wrap it snugly, but not too tightly.
-- Elevation: To reduce inflammation and pain, prop up your foot above waist level.
If needed, take a nonprescription pain reliever. If your tendon is swollen and warm, try ibuprofen or naproxen.

Once the pain and swelling are gone, gently stretch your tendon to strengthen it.

If the pain and swelling persist, see a foot care specialist. He or she may recommend physical therapy. The doctor may also prescribe heel lifts or Achilles' heel cushions to provide support and take pressure off your injured tendons. A night splint can help too, by keeping the Achilles tendon in a stretched position while you sleep.

Avoid steroid injections into the inflamed area around the tendon, as the steroids can weaken the tendon and make it more likely to rupture.

Be patient. These conditions can take six to 12 months to heal. If your tendon has completely ruptured or torn away from the bone, you may need surgery.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)

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