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Achilles Tendinopathy

What is it?

Achilles tendinopathy refers to a condition characterised by pain and inflammation of the Achilles tendon, which connects the calf muscles to the heel bone. It typically results from overuse, repetitive strain, or injury, and can lead to degeneration of the tendon tissue.

What causes it?

Achilles tendinopathy is primarily caused by a combination of factors related to overuse and strain on the Achilles tendon.
Here are some common causes:

Overuse

Repetitive activities, especially high-impact sports like running, jumping, or dancing, can lead to microtears in the tendon.

Sudden Increase in Activity

Rapidly increasing the intensity or duration of physical activity can overload the tendon.

Improper Footwear

Shoes that lack proper support or cushioning can increase stress on the Achilles tendon.

Tight Calf Muscles

Limited flexibility in the calf muscles can place extra strain on the tendon.

Biomechanical Issues

Abnormal foot mechanics, such as flat feet or high arches, can lead to uneven distribution of forces on the tendon.

Previous Injuries

A history of ankle or tendon injuries can increase the risk of developing tendinopathy.

Age

Tendons lose elasticity and strength as we age, making older adults more susceptible to injuries.

Chronic Conditions

Conditions like diabetes or inflammatory diseases can affect tendon health.

Training on Hard Surfaces

Running or exercising on hard surfaces can increase impact stress on the tendon.

Addressing these risk factors through proper training, footwear, and flexibility exercises can help prevent Achilles tendinopathy. If
symptoms occur, it’s essential to seek appropriate treatment to avoid further complications.

How is it diagnosed?

Achilles tendinopathy is typically diagnosed through a combination of patient history, physical examination,
and imaging studies. Here’s a breakdown of the process:

  • Patient History: Your podiatrist will ask about symptoms, including the onset, location, and nature of pain, as well as any recent changes in activity level or footwear.
  • Physical Examination: The podiatrist will examine the Achilles tendon for tenderness, swelling, or thickening. They may also assess range of motion and strength in the ankle.
  • Imaging Studies
  • Ultrasound: Often used to visualise the tendon and check for abnormalities like tears or thickening.
  • MRI:
    • Provides detailed images and can help assess the extent of the injury.
  • Functional Tests: The podiatrist may evaluate how the tendon performs under stress, such as during walking or specific exercises.
A combination of these methods helps confirm the diagnosis and rule out other conditions, such as tendon tears or ruptures.

How is it Treated?

Achilles tendinopathy treatment often involves a multi-faceted approach, focusing on reducing pain, promoting healing, and preventing recurrence. Here are the common treatment strategies:

Rest and Activity Modification

Reducing or avoiding activities that exacerbate the pain is crucial. Cross-training with low-impact activities (like swimming or cycling) may be recommended.

Ice Therapy

Applying ice to the affected area can help reduce swelling and pain, especially after activity.

Physiotherapy

A physical therapist can design a rehabilitation program that may include:

  • Stretching and strengthening exercises
  • Eccentric loading exercises, which have been shown to be effective for tendon healing
  • Manual therapy techniques

Footwear and Orthotics

Proper footwear that provides support and cushioning is important. Custom orthotics may be recommended to correct biomechanical issues.

Medication

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help reduce pain and inflammation.

Corticosteroid Injections

In some cases, injections may be considered, but they are used cautiously due to potential risks.

Shockwave Therapy

Extracorporeal shockwave therapy (ESWT) may be used to promote healing in chronic cases.

Frequently Asked Questions

What causes Achilles tendinopathy?
It can result from overuse, especially in athletes who increase their activity level too quickly. Other factors include improper footwear, biomechanical issues, tight calf muscles, and previous injuries.
Healing time varies; mild cases may improve in a few weeks, while more severe cases can take several months. Adhering to a treatment plan is crucial for recovery.
Low-impact activities (like swimming or cycling) are usually safe, but high-impact activities should be avoided until symptoms improve. A healthcare provider can recommend appropriate exercises.
To reduce the risk, gradually increase activity levels, ensure proper footwear, incorporate stretching and strengthening exercises for the calf muscles, and cross-train to avoid overuse.
Yes, but a gradual return is important. Follow your healthcare provider’s advice on when and how to safely resume activity.

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