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Achilles Tendon Pain

The majority of Achilles tendon pain is of a slow onset, over-use nature – compared to a sudden acute tear or rupture of the tendon. Recent research however suggests this type of injury does not involve inflammation (tendonitis); instead is a weakening and degeneration of the tendon (tendinosis/ tendinopathy).

The achilles tendon is the large tendon located in the back of the leg that connects the calf muscle to the heel. Enormous load goes through this tendon as it gives us the ability to toe off during walking, running and jumping activities.

Achilles tendon pain (tendinopathy) is most common among middle-aged people and athletes.

Signs and symptoms

  • Gradual onset without initial injury
  • Initially pain may only be felt during exercise, as injury worsens pain may also be present during normal daily activities.
  • Pain, tenderness and swelling around tendon
  • Pain and stiffness most noticeable in the morning upon arising and after rest periods during day
  • Weakness when jumping, hopping or skipping on affected leg

Causes

Often there has been an increase in load placed on your lower limb that your body has not had the capacity to deal with resulting in injury. This increase in load may be due to:

  • Change in training intensity, introduction of hill running, speed work, more plyometric (jumpy) activities
  • Inadequate rest between training sessions
  • Starting to exercise from scratch; or returning to exercise after pro-longed period of rest (too much, too soon!)
  • Occupations/ hobbies spending lots of time on your feet, especially hanging heel over ladders, working on inclines such as hills/ roof etc.
  • Wearing unsupportive or incorrect footwear or lots of barefoot walking
  • Weight gain

Certain foot types increase risk of developing achilles tendinopathy:

  • Rigid high arch foot type increases compression load at Achilles tendon
  • Pronated / collapsed arch foot type increases load on the tendon
  • Tight posterior chain (hamstrings / calf muscles)
  • Restricted ankle joint or big toe joint dorsiflexion

Other factors that may increase the risk of developing achilles tendinopathy and/or impair your body’s own ability to repair the injury:

  • Medical factors – Insulin resistance/ Type 2 Diabetes, Rheumatoid arthritis and other conditions affecting integrity of collagen fibres

  • Menopause can affect tendon resilience and repair
  • Age 30 +; overweight
  • Some medicines (eg. steroids, antibiotics) may increase the risk of Achilles tendon injury
  • Lifestyle factors such as inadequate sleep and stress affect your body’s ability to repair injured tissue

Treatment

Treatment for Achilles tendinopathy depends on the location of injury and whether it is in the reactive or degenerative stage of injury. This is really important!

The 2 locations where achilles tendinopathy will present – insertional or midportion.

Insertional Achilles tendinopathy – at the insertion of the tendon into the heel bone (back of heel). This tendinopathy is due to excessive compression load on the tendon.

Midportion Achilles tendinopathy– within tendon normally 2-3cm above insertion into heel.

Like most over-use soft tissue injuries – our approach at Foundation Podiatry to managing Achilles tendinopathy is to "calm it down – build it up". 

> This may initially involve certain footwear, modifying activity, avoiding certain stretches etc.
> Address any foot and lower limb biomechanics that may be contributing to the overload/compression of your tendon.
> If you’ve had your pain for some time and the tendon is quite degenerative then an assistance in tissue healing may be required through Medical Acupuncture, Low Level Laser therapy or Shockwave therapy.

Then most importantly a progressive tendon loading/ strengthening program needs to be introduced at the right time with the goal of getting your tendon resilient enough to once again handle the load required for your particular physical activity/ occupation.

Because of the progressive nature of Achilles tendinopathy, it is best to seek treatment as soon as possible. Early treatment allows for a much greater prognosis and minimises the risk of chronic tendon degeneration or rupture.

For chronic, resistant Achilles tendinopathy - Shockwave Therapy is the recommended treatment option as it is non-invasive, highly effective and relatively pain-free. Cortisone injection is not recommended and if left untreated for a long time surgery may be necessary.

Don’t hang up the boots due to unrelenting Achilles tendon pain affecting your game – give Foundation Podiatry a call today!

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