Achilles tendonitis is a very common injury, particularly in runners. It is estimated that Achilles tendonitis accounts for around 11% of all running injuries. The Achilles tendon is found in the back of the ankle, and is the largest tendon in the human body. The Achilles tendon is fibrous tissue that connects the heel to the muscles of the lower leg: the calf muscles (Gastrocnemius and Soleus) to the heel bone (calcaneus) and provides the power in the push off phase of the gait cycle (walking and running). Depending upon speed, stride, terrain and additional weight being carried or pushed, each Achilles tendon may be subject to up to 3-13 times a person's body weight during a spring or push off. Many athletes can suffer from Achilles tendonitis: runners, basketball players, footballers, volleyball players etc.
Achilles tendonitis is often now being referred to as Achilles tendinopathy. This is because it is a non-inflammatory condition of the tendon. On investigation, the inflammatory cells are not found and usually degenerated tissue with a loss of normal fibrous structure could be seen on microscopic examination.
Achilles tendonitis can be either acute, meaning occurring over a period of a few days, following an increase in training, or chronic which occurs over a longer period of time. 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). Healing of the Achilles tendon is often slow, due to its poor blood supply.
Symptoms of achilles tendonitis
- Gradual onset of pain over a period of days.
- Pain at the onset of exercise which fades as the exercise progresses.
- Pain eases with rest.
- Tenderness on palpation.
- Gradual onset of pain over a period of weeks, or even months.
- Pain with all exercise, which is constant throughout.
- Pain in the tendon when walking especially up hill or up stairs.
- Pain and stiffness in the Achilles tendon especially in the morning or after rest.
- There may be nodules or lumps in the Achilles tendon, particularly 2-4cm above the heel.
- Tenderness on palpation.
- Swelling or thickening over the Achilles tendon.
- There may be redness over the skin.
- You can sometimes feel a creaking when you press your fingers into the tendon and move the ankle.
The common causes of achilles tendonitis:
- Increase in activity and intensity (distance, speed or hills).
- Less recovery time between activities.
- Incorrect shoes are a common cause, where the training shoe provides either insufficient cushioning or insufficient support.
- Training surfaces (running on hard surfaces creates greater impact).
- Excessive foot pronation (inward movement of the rear foot).
- Lack of flexibility and the lack of strength of the calf muscles.
Treatment of achilles tendonitis
What can you do?
- Rest or training modification (lower intensity, cut back mileage, avoid hills).
- Avoid excessive stretching for your Achilles tendon and gentle stretch after warm up.
- Apply ice pack several times a day to the affected area.
- Wear a heel pad to raise the heel and take some of the strain off the Achilles tendon.
- Wear right running shoes according to your foot type and the sport.
- Check your running shoes and replace if heel is worn and See a sports injury professional who can advise on treatment and rehabilitation.
Our podiatrist at Temple Clinic can help you by:
- Prescribing anti-inflammatory medication such as ibuprofen.
- Identifying the causes and prescribe orthotics or a change in training methods.
- Footwear advice.
- Using taping technique to support the tendon and limit and prevent abnormal moment.
- Using ultrasound treatment.
- Applying sports massage techniques and strength and flexibility exercise.
Specialised consultation and care for achilles tendon injury at Temple Clinic in Ealing, West London