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 Achilles Tendinopathy?

There are several causes

  • 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
Podiatrist Mobilizing Foot 1

Clinical features that can point toward a diagnosis of Achilles Tendinopathy

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?

A diagnosis is based on the clinical reasoning behind what you are feeling and how your symptoms present. Your Podiatrist will palpate the painful area, will assess your mobility, strength and movement patterns to ascertain the root cause of your pain. If required, an ultrasound scan may be performed.

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

Tips for Achilles Tendinopathy Treatment & Manangement

Tendon pain is by definition pain associated with sudden changes in tendon energy storage and compressive loads, which warms up or improves with activity, and is localised to the tendon (Cook & Purdam 2012).

What does that mean?
This means that any changes in load – running further than usual, running more frequently, changing the surface you run or play sport on or even wearing a different pair of shoes – can all contribute to a tendinopathy.

If there’s one thing about tendons, it is that they do NOT like change!

You’ll often find with tendon pain that the area can feel sore when you start your activity. The area will tend to “warm up” and the pain dissipates, then after you’ve finished usually later that day or evening it will feel stiff and sore again. It tends to be quite a localised pain which can be guided to with one or two fingers to point.

When should you see a Podiatrist for Achilles tendon pain?
Ideally, clinical input should be sought even with a mild niggle of pain. Pain is not normal!
Often though what we see clinically is unrelenting pain that has been present for weeks or months and is not clearing. If you can get onto it sooner it is generally quicker to settle and easier to manage.

A Podiatrist will identify key factors that are contributing to your pain and assist you in load management, and rehabilitation back to your activity.

3 steps to keep a healthy Achilles tendon:

  1. Foam roll and stretch the calves
    Concentrate on both sides of the calf muscle and focus on loosening any knots within the muscle. Any tightness within the calf muscle will result in more tension within the tendon which can lead to pain in the area.
  2. Complete rest does not help!
    Although rest may seem like a good option it generally will not help much with your pain. Especially if you are wanting to continue in being active. The most important way to go ahead is through active recovery and avoiding aggravating activites.
  3. Slowly increase load
    Although it is tempting to push your limits fast, it can sometimes lead to pain and disappointment. It is best to slowly graduate your training and sensibly increase your load. Your tendons will thank you!

For more advice on Achilles tendinopathy please send your questions through, we would love to hear from you!

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