Causes of Achilles Tendinopathy

The Achilles tendon is an important structure that helps you walk, run, jump and stand on your toes. The tendon connects the calf muscle to the heel bone, and assists with transmitting force, acting like a spring when you push your foot off the floor. It is the largest tendon in the body and is therefore capable of withstanding a considerable amount of stress, up to 8 times your body weight. Achilles tendinopathy generally occurs when the tendon is excessively loaded with more force than it is used to, resulting in cellular changes to the tendon’s structure.

Here are some of the risk factors that can contribute to tendon overload:

– Sudden increase in intensity, frequency or duration of activity
– Excessive training and inadequate rest periods
– High impact activities that require rapid directional change
– Inadequate warm up, stretching and cool down
– Poor footwear or ill fitting shoes (eg. high heels)
– Tight and or weak calf muscles
– Altered biomechanics contributing to increased Achilles strain (eg. excessive pronation)
– Being overweight
– Underlying medical conditions (eg. diabetes, high cholesterol, inflammatory arthritis)
– Certain medications (steroids and fluoroquinolone antibiotics have been associated with Achilles tendon ruptures)

Symptoms

Classic features of Achilles Tendinopathy include:
– Pain and stiffness at the back of the heel, or 2-6 cm above from the base of the Achilles
– Pain in the Achilles before and after exercise. It may increase or flare up when activity stops. In some cases pain in the Achilles may prevent you from participating in activity altogether.
– Stiffness around the area of the back of the heel in the morning which may subside after exercise and movement
– The affected area can be swollen, warm and tender to touch
– Bony spurs at back of the heel – this is usually painless but can cause irritation from footwear

Diagnosis

At Dapto Foot Clinic, we can diagnose Achilles tendinopathy through a biomechanical assessment, where we take a detailed medical history, look at muscle strength and function, footwear and gait. We may use further imaging such as x-ray, ultrasound or MRI to determine the exact location and pathology of the tendon, and may want to assess surrounding structures. 

Treatment of Achilles Tendinopathy

Treatment of Achilles tendinopathy is focussed on reducing aggravating factors to the tendon through offloading and controlling the foot biomechanics. This will be followed by rehabilitation to improve the tendon’s pain free load capacity through exercise, with the goal to prevent future injury. This will involve:

– Modified activity, avoiding activities which may cause the tendon to flare up
– Strapping for short term relief
– Heel raises applied to insoles to reduce tension off the Achilles tendon, usually required for short term
– Exercises: Stretching, strengthening and functional exercises for calf muscle/tendon complex. We would usually provide you with a progressive loading program.
– Custom foot orthotics to address any biomechanical issues that can contribute to Achilles tendon strain
– Footwear education and advice
– Manual therapies (ie. dry needling, soft tissue and deep tissue massage), to release calf muscle tightness
– Shockwave therapy to accelerate and facilitate healing

More information can be found at the American College of Foot and Ankle Surgeons