Achilles Tendinopathy

 The Achilles tendon is a large tendon that runs down the back of the leg and attaches the calf muscles to the heel bone. The Achilles tendon allows the calf muscles to push off during walking and running.

Achilles Tendinopathy is a condition that causes pain, swelling, stiffness and weakness of the Achilles tendon. It is commonly an overuse injury and is common in runners and athletes who train heavily or require a lot of jumping movements, such as ballet dancers. It can also occur in less active people who recreationally walk or stand for long periods.

The pain can vary from mild to severe and is often described as a pulling, shooting or burning pain.  It can even be an intense piercing pain located at the back of the leg, ankle or heel. The pain can be aggravated by activities that repeatedly stress the tendon, causing inflammation or pain in the first few steps of the morning or after sitting down for extended periods of time, which gets better with mild activity or when warmed up.

The two most common injuries of the Achilles are tendinopathy and rupture due to excessive loading of the Achilles. Overloading can occur due to one or many of the following:

• An increase in activity (frequency, intensity and or duration) of activity A decrease in recovery time between activity
• Unsupportive or very flat footwear
• Excessive pronation
• Running on hard or uneven surfaces
• Tight or weak calf muscles
• Stiff ankle joint – reduced range of motion at the ankle joint
• Inadequate warm-up or cool-down with training and exercise

Immediately treating acute soft tissue injury involves the RICER protocol – rest, ice, compression, elevation and referral.

RICE protocol should be followed for 48 – 72 hours. The aim is to reduce the bleeding and damage within the joint.

The No HARM protocol should also be applied – no heat, no alcohol, no running or activity, and no massage. This will ensure less bleeding and swelling in the injured area.

Treatment includes rest, pain relief, strengthening exercises, and changes in sports techniques and footwear to reduce stress on the tendon. Orthotic therapy and Surgery may also be indicated.

Achilles Tendinopathy can take weeks to months of rest for the tendon to heal slowly. Unfortunately, the blood supply to the tendon is not strong, and rehabilitation can be a long process.

Once pain has settled, exercises and stretches may be prescribed to strengthen the tendon to cope with the load and return to activity.

Other treatments may include ultrasound therapy, mobilisation, dry needling, shock wave therapy, stretching, massage and orthotics. Anti-inflammatory medication may also be indicated. A completely ruptured Achilles will require a surgical referral. Return to activity must be gradual, usually aided with heel raises and taping.