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Achilles Tendinopathy

What is Achilles Tendinopathy?

Achilles tendinopathy describes pain and dysfunction in the Achilles tendon, this connects the muscles of the calf (gastrocnemius and soleus) to the back of the heel bone (calcaneum). It acts like a spring allowing us to run and jump, although if its capacity is exceeded, tendinopathy may develop.  It is caused by increased numbers of cells in the tendon that try to fix the issue of excessive load and therefore causes chronic pain in the tendon. It is commonly thought to be inflammation although this still has not been proven.

Achilles tendinopathy has two types of tendinopathy, either at the insertion (right where it attaches on to the heel), or at the mid-portion (in-between the muscles and the heel bone). This is important to decipher which one it is as they have different treatment methods.

Causes of Achilles Tendinopathy

Achilles tendinopathy is caused by a serve change in load or activity. This change may be due to a sudden increase in training loads in athletes or beginning an exercise program for office-bound individuals.

The Achilles insertion is compressed in positions where the foot is bent up (dorsiflexion). These positions combined with high energy storage tendon loads (running and jumping) may lead to the development of symptoms. Other factors that contribute to this condition include the following:

  • Fluoroquinolone antibiotics and statin medications
  • Genetic factors
  • Obesity
  • Poor function of the lower limb muscles.
  • Type 2 diabetes

More factors that are included but are not associated with the development of Achilles tendinopathy:

  • Age
  • Foot Pronation
  • Poor Flexibility

Do I have Achilles Tendinopathy?

Achilles tendinopathy causes very localised pain where the Achilles attaches to the heel in insertional cases, or between the heel bone and muscle in mid-portion cases. The pain should not cover a larger area than the size of a coin or similar nature. This issue usually affects both young and older distance runners. Most commonly, there may be pain or stiffness first thing in the morning, the tendon may appear thicker and it may be sore after walking.

Our physiotherapists will be able to diagnose Achilles tendinopathy. To do this they will ask you certain questions about your past and present experiences whilst performing a range of short tests. It is important to complete these tests are a vast variety of other conditions can have similar effects. Scans such as MRI or ultrasounds are not necessary to diagnose this condition and will only be used if the physiotherapist believes it could be some other condition.

How can physiotherapy help with Achilles tendinopathy?

Our physiotherapist will be able to provide you will a individual treatment plan that is right for your situation. This plan will focus on reducing pain. It will be important to modify and temporarily reduce any high load activities. Once your pain is has been minimised, it is important to begin strengthening the entire leg. For the best outcome, it may be required to use gym equipment or weights. Once your leg becomes stronger and pain is reduced actives can be then slowly introduced. Once your physiotherapist is happy with results you may ease back into whatever activity you wish to complete.

There are no ‘quick-fixes’ for Achilles tendinopathy and the following treatments are not supported:

  • Injections
  • Ultrasound, laser or electrotherapy
  • Stretching

How effective is physiotherapy for Achilles tendinopathy?

Exercise should form the main element of all treatment for Achilles tendinopathy, and is recommended as a first line treatment. Isometric exercises (holding exercises) have also been shown to be effective at reducing pain.

Can I do anything at home?

Once your individual plan has been made by your physiotherapist, you will need to complete a range of exercises at home as directed to improve your strength and capacity. To monitor yourself, follow your symptoms first thing in the morning whether it is the same or better than the previous day. If this pain worse than the day before the activity you completed has overloaded your tendon.

How long until I recover?

Achilles tendinopathy requires lengthy rehabilitation, but it depends on the level of your pain and dysfunction and what activity you want to return to. At minimum, 3–6 months of strengthening will be required to get back to your activity and may be longer depending on your situation.

If you would like to find out more please call us or book an appointment here.

Back to Physiotherapy for Your Ankle.

Reference: Australian Physiotherapy Association 2019, Your Body, viewed 19 November 2019, < https://australian.physio/>.