Achilles Tendonitis or Achilles Tendinopathy

Achilles Tendinopathy or Achilles tendonitis is a common overuse injury affecting both men and women. It is seen in across all age groups and affects people of varying fitness levels.

As the name entails, Achilles Tendinopathy affects the Achilles tendon, which is the cord like structure at the back of your ankle connecting the calf muscles to the heel bone.

Achilles tendinopathy refers to damage of the tissues which make up the Achilles tendon and associated pain felt in the region. It is an injury that generally develops over time (due to overuse) as oppose to a once-off incident.

What does it feel like?

The way in which it presents can differ, often the signs and symptoms of Achilles tendinopathy vary based on the severity of the injury. It typically presents as pain or stiffness in the Achilles tendon felt when commencing activity, often following a period of rest. Pain is can be present in a couple of areas i.e. in the middle of the Achilles tendon (mid-portion Achilles tendinopathy) or at it’s attachment into the heel bone (insertional Achilles tendinopathy).

Symptoms occasionally ease with continued activity and often feels as thought the area has “warmed up” but return again once activity has ceases. Swelling and thickening can be also be seen in the Achilles tendon, but is not always present.

In more severe cases of Achilles tendonitis, symptoms can persist and even worsen with activity, making movement on the effect side difficult.
What causes it?
Like most musculoskeletal injuries, the cause of Achilles tendinopathy is often multifactorial – meaning that it is caused by a number of factors occurring at the one time.

Contributing factors in the development Achilles tendinopathy include:

  • Overuse: Increasing the volume, intensity or frequency of exercise too rapidly, or allowing insufficient recovery in between exercise sessions.
  • Uneven training surfaces: unstable surfaces can over work your muscles and if they are not conditioned for it, injury can occur.
  • Tight and/or weak calf muscles
  • Poor footwear Excessive pronation (rolling in) of the feet

What can you do to manage it?

Like any injury, early diagnosis and treatment of Achilles tendinopathy is crucial to achieving a successful outcome. If you suspect that your symptoms are similar to those outlined for Achilles tendinopathy, you should seek an assessment from your podiatrist so that a management plan can be developed for your injury to get you pain free as quickly as possible.

Your podiatrist may utilise the treatment skills of other health professionals such as a physiotherapist, myotherapist or sports physician to assist in the management of your injury.

Typical conservative treatments for Achilles tendinopathy include:

  • Activity modification – reassessing you training program
  • Calf stretching and Achilles strengthening exercises
  • Anti-inflammatory strategies
  • Massage
  • Changes to your footwear
  • Taping or Strapping
  • Orthotics may be required to improve your foot position or function

In more persistent Achilles Tendinopathy cases, treatments such as
Extracorporeal shockwave therapy,
Cortisone injections
Platelet rich plasma or autologous blood injections may be considered
Surgical treatment is also available for Achilles tendinopathy but is generally only considered when all conservative treatments fail.

What should you avoid doing?

Do not ignore these symptoms and hope that your injury will settle down or improve. Often things may feel as though they are improving but then excessive activity and force can result in the recurrence of this injury where eventually the injured region no longer “warms up” or improves and therefore may not respond to more conservative management options.

Management:

Your podiatrist will provide you with a thorough assessment of your Achilles pain to accurately diagnose the condition and rule out other conditions which may have similar signs or symptoms. In developing your management plan for Achilles tendinopathy , your podiatrist may use a combination of therapies including: stretching and strengthening exercises, icing, massage, taping techniques, dry needling, footwear changes, and a return to activity program. The use of orthotics may also be considered in the management of Achilles tendinopathy. If you are having trouble with your Achilles,contact Walk On Podiatry today.

 

Dominic Sanó is a sports podiatrist at Walk On Podiatry Hastings and Walk On Podiatry Frankston having worked closely with many people suffering sports related and running injuries over the years helping people not only with the treatment of their injuries but also focusing on preventative strategies.