What Is Achilles Tendinopathy?
Achilles tendinopathy also called Achilles tendinitis is a painful condition at the back of the heel occurring when the tendon that connects the calf muscle to the calcaneus (heel bone) becomes inflamed.
Achilles tendinopathy is an overuse injury that commonly effects runners, jumpers or athletes , however it can effect anyone at anytime particularly if you have changed your exercise regime.
Why is the Achilles Tendon Important?
The Achilles tendon is a large tendon that attaches your calf muscles to your heel bone.
It is essential for propulsion during gait, and is commonly injured in both the professional and novice athlete.
Figure 1 shows the calf muscles (Gastrocnemius and Soleus) inserting into the Achilles tendon which attaches to the calcaneus (heel bone).
The Achilles tendon coupled with the calf muscle helps to raise the heel off the ground.
Without the Achilles tendon it would be difficult to carry out daily activities such as walking, running, jumping, skipping and even climbing stairs.
It is the strongest and thickest tendon in the body and when the Achilles tendon becomes inflamed, ruptured or torn completely it takes a long time to heal.
What is Achilles Tendinopathy?
Achilles tendinopathy is much more than just an inflamed tendon. Achilles tendinopathy is several small tears within the tendon sheath caused by overuse.
It is caused by a degeneration of the collagen protein that forms the tendon.
Causes of Achilles Tendinopathy
Achilles Tendinopathy is an overuse or repetitive stress injury caused by excessive walking, running, jumping or stair climbing.
It can occur with increased exercise regimes, a lack of warm up or even upon casual weekend sports without gradual increase of training intensity.
It is commonly seen in athletes who undertake sports requiring rapid movement including stopping, starting, jumping and twisting such as tennis, football, basketball and even ballet.
Other common causes include:
- Ill fitting footwear or footwear not designed for your activity
- Wearing of high heels
- Hill running
- Ageing and lack of muscle tone
- Obesity or increased load are also causes of Achilles Tendinopathy
- Your Sex – Achilles tendinopathy is more common in men due to large calf muscle fibres.
- Sudden increase of activity level.
- Poor footwear choices.
Signs and Symptoms
Common symptoms of Achilles Tendinopathy include inflammation, pain or thickening along the Achilles tendon, and stiffness at the back of the heel in the morning.
Your pain and swelling can occur anywhere along your calf muscle, Achilles tendon or heel bone and can increase with activity.
Another symptom is severe pain the day after exercising. On X ray, a heel spur can often be seen at the Achilles tendon insertion.
Management of Achilles Tendinopathy
There are many different ways to treat Achilles Tendinopathy with varying results depending on the severity of your condition.
When used in conjunction with stretching exercises night splints are a effective treatment of early onset Achilles tendinopathy as they hold the tendon in a gently stretched position while you sleep and elongate your calf muscles.
Stretching and Strengthening Programs
Upon leaving Erica Dash Podiatry after your initial consultation for Achilles Tendinopathy it is not uncommon your podiatrist will have recommended a gentle exercise regimen incorporating stretching exercises.
As you progress through your treatment, you will be issued with a strength training program incorporating eccentric exercise. Eccentric exercise is an effective way of strengthening the Achilles tendon and allowing the inflammation to decrease.
Foot Mobilisation Therapy Using Muscle Energy Technique
Foot mobilisation through muscle energy technique can correct the position of the talus, the bone directly above your heel bone forming your ankle joint.
When your talus sits in its optimum position, more flexibility occurs through the calf muscles and in turn will release strain on your Achilles tendon.
Dry needling is one of the treatments offered at Erica Dash Podiatry for Achilles tendinitis; it is a therapy where a fine needle is introduced into a trigger point within your muscle belly causing it to release.
Upon release of the trigger point your podiatrist will apply a gentle stretch to the muscle teaching it a new length. Dry needling for Achilles tendinitis and Achilles tendinopathy is usually performed upon trigger points within your soleus and gastrocnemius (calf) muscles.
A heel raise placed inside your shoes will reduce strain on your Achilles tendon. Heel raises are particularly useful for people with shortened calf muscles wishing to increase their activity levels to avoid Achilles tendinitis, it is also important to couple a heel raise with a structured stretching regime.
Orthotic therapy is a treatment option for sports people, runners and athletes with Achilles tendinopathy. Orthotics can improve running technique by reducing overpronation, one of the risk factors of Achilles tendinopathy.
An orthotic provides load management to the Achilles tendon and stabilises your foot and ankle during exercise. Orthotics provide added shock absorption which reduces stress and strain on your leg, back and ultimately your whole body.
Weight Bearing Casts
For chronic Achilles Tendinopathy or partial tears in the Achilles tendon, it may be necessary to wear a weight bearing cast to immobilise the foot and ankle and allow the tendon to properly heal.
After wearing your weight bearing cast for several weeks your podiatrist will recommend a strength training program prior to returning to sport.
Shock wave therapy is a series of soundwaves applied to your Achilles tendon and surrounding muscles. It is these soundwaves that increase blood flow to your tendon and promote healing.
Shock wave therapy has been used for several years to treat tendon injuries. It is effective in decreasing Achilles pain and also a useful therapy for promoting healing if used both before and after surgery for Achilles tendinopathy.
Shock wave therapy is a recommended treatment for Chronic Achilles tendinopathy sufferers. The energy produced by shock wave therapy promotes regeneration of ground substance within the Achilles tendon.
Corticosteroid injections are used to treat many conditions, however they are certainly not recommended for Achilles Tendinopathy sufferers.
This is because injection of a steroid directly into tendon tissue can weaken it and put the tendon at risk of rupture or complete tendon dysrepair.
Surgery is only recommended for a complete tear to the Achilles tendon; this is due to the amount of scar tissue to overcome. During the surgery, the surgeon will stitch the torn tendon back together.
If there is atrophy or damage to the tendon, the surgeon will need to remove the damaged portion and stitch the healthy tendon back together again thus resulting in a shorter tendon.
Achilles Tendon Rupture
When athletes rupture an Achilles tendon a loud pop or snapping sound is usually heard.
It is painful and is characterised by inflammation and tenderness in the lower leg.
Your podiatrist will order an ultrasound to determine the extent of your injury and the best treatment options moving forward.
Treatments for Achilles Tendon Rupture
Depending on your age and activity level will depend on your choice of treatment.
The younger sports person usually opts for surgical intervention to repair a completely ruptured Achilles tendon, whereas an older people will usually choose a non-surgical treatment. Non surgical options include:
- Over the counter pain relief
- Rest and ice during the early stages
- The wearing of a weight bearing cast to immobilise the area
Following whichever treatment you choose, you will require physical therapy to strengthen the area and allow it to return to normal load. Tendon injuries can take up to 6 months to heal.
Your health professional will recommend you persist with your rehabilitation exercises for an extended period after they have given you clearance to stabilise and strengthen your tendon and prevent further injury.
Shockwave is a great alternative to treatments such as dry needling if you’re needle phobic and not keen on dry needling. We also have effective treatment offers for kids.