Achilles tendonitis is categorised by tissue damage and pain in the Achilles tendon. A tendon is a band of strong connective tissue that connects muscle to bone. The Achilles tendon is the largest tendon in the body and it attaches the calf muscles - the Gastrocnemius and Soleus, to the heel bone . the calcaneus. Its action is to plantar flex the foot, and therefore it provides the power for the .push off. phase of walking and running and allows you to stand on tiptoe.
Achilles tendonitis is often now referred to as Achilles Tendinopathy which is the more correct medical term. This is because it is no longer thought to be an inflammatory condition. On investigation, the main finding is usually degenerated tissue with a loss of normal fibre structure. The Achilles tendon is found to have with small, focal lesions within the tendon, surprisingly without an inflammatory response. This degeneration means that the tendon does not have its normal strength and it may be at risk of rupture with continues overload.
In most cases, Achilles tendonitis is a type of overuse injury commonly seen in runners following an increase in training, hill/stair training, a change of footwear or training surface, or weak or tight calf muscles. Overpronation or feet which roll inwards when running can place an increased strain on the Achilles tendon. People who play sports that involve jumping, such as basketball, are also at increased risk. However it is also a common overuse injury in people not involved in sport. Wearing high heels constantly shortens the tendon and calf muscles and walking or exercising in flat shoes stretches the tendon is beyond its normal range which places an increased strain on the tendon.
Healing of the Achilles tendon is often slow, due to its poor blood supply. Acute tendonitis often presents with pain at the start of exercise which fades as the exercise progresses. It eases with rest and is painful to touch. Chronic Achilles tendonitis may follow on from acute tendonitis if it goes untreated or is not allow sufficient rest. Chronic Achilles tendonitis is a difficult condition to treat. It presents with pain with all exercise, which is constant throughout. Pain when walking especially uphill or up stairs, and pain and stiffness in the Achilles tendon especially in the morning or after rest. There may be lumps in the Achilles tendon, particularly 2-4cm above the heel. Swelling or thickening over the Achilles tendon may be present and there may be redness over the skin. In addition to being either chronic or acute, the condition can also be either at the attachment point to the heel or in the mid-portion of the tendon (typically around 4cm above the heel).
Treatment includes rest and ice. Wearing a heel pad can take some of the strain off the Achilles tendon. This is only a temporary measure while the tendon is healing. A Physiotherapist can make sure you have the right running shoes for your foot type and the sport. They may suggest anti-inflammatory medication such as ibuprofen. They can identify the causes of the injury, prescribe rehabilitation and suggest a change in training methods if necessary. A Physiotherapist can also tape the back of the leg to support the tendon, use ultrasound treatment, apply soft tissue techniques and use acupuncture.
You may be given specific exercises to gently stretch and strengthen the calf. Your physiotherapist will recommend these exercises when you are ready, including an eccentric strengthening programme. Eccentric muscle strengthening refers to a muscle that is lengthening while working. Gradually increasing the causes the Achilles tendon to adapt and get stronger. Recovery is often slow and will depend on the severity of the condition and how carefully you follow the treatment and care instructions you are given. Some people may require a scan with an MRI or Ultrasound. Other investigative tests may include an x-ray of the foot and occasionally blood tests (to test for an inflammatory condition).
Unfortunately some people might have to have a steroid injection or surgery if conservative treatment fails. Surgery is considered the last resort. In this case badly damaged portions of the tendon may be removed. If the tendon has ruptured, surgery is necessary to re-attach the tendon. Your Physiotherapist will guide you through your rehabilitation, including stretching and strength exercises. In most cases this is started soon after the surgery, and normal activities can be resumed after about 12 weeks. Return to competitive sport for some people may be delayed for about six months.
If you look after an Achilles injury early enough you should make a good recovery. It is important you fully rehabilitate the tendon properly after it has recovered or the injury will return. Ignoring warning signs and not looking after your Achilles may lead it to become chronic which is very difficult to treat.
Here are some suggestions to reduce your risk of Achilles tendonitis: