Achilles Tendinopathy – what is it?
Achilles Tendinopathy is damage of the Achilles tendon at the back of the ankle. It’s one of the most common tendon injuries and is usually associated with pain or swelling. Sometimes the tendon may thicken or a nodule (lumpy build-up of scar tissue) may be felt.
The muscle group at the back of the leg is commonly known as the calf. The calf comprises of 2 major muscles, the gastrocnemius and the soleus. Both muscles insert into the Achilles tendon.
During contraction of the calf, tension is place through the Achilles tendon. When the tension is excessive, damage to the tendon can occur. This damage to the tendon subsequently causes degeneration. This may occur due to a high traumatic force going through the tendon or due to gradual wear and tear associated with overuse.
It should be noted that the cell changes within the tendon are not reflective of inflammatory changes. Research now suggests strongly that the proper terminology is now Achilles Tendinopathy, and that Achilles Tendonitis is no longer a medically accepted diagnosis. As such, the tendon is managed with this in mind, and treatments targeted at inflammatory changes are largely ineffective.
What causes it?
- Sudden increases in training – duration/intensity, excessive hill running, speed work or training on uneven surfaces.
- Poorly functioning feet – can cause the heel to shift outwards and “bow” the Achilles tendon, damaging the sheath and resulting in painful inflammation.
- Tight calf and hamstring muscles – may contribute due to the “pulling” strain they exert on the tendon
- Unsupportive footwear
- Excessive or restrictive ankle joint mobility
Typical clinical features will be present with Achilles Tendinopathy including:
- A history of an increase in activity levels and time on your feet
- Swelling present around the tendon
- Pain in the tendon or the back of the heel bone
- Loss of strength through the leg
- Loss of power and confidence with jumping or running
- Stiff and sore in the morning and toward the evening
- Tends to warm up with movement and get stiff and sore at rest
How it is diagnosed
How it is treated?
Achilles tendinopathy responds well to conservative treatment if treated early. Conservative treatments include:
- Specific strengthening exercises – to load the Achilles tendon in a controlled and progressive form
- Heel raises – to decrease the strain and load on the Achilles tendon
- Correction of abnormal mechanics – through strengthening of the foot, hip and pelvis to result in ideal alignment through the whole limb
- Custom orthotics that allow the foot to function around a position which reduces the strain being applied to the tendon. This allows it to recover and prevents reoccurrence of injury
- Footwear advice
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