Achilles tendinopathy

Achilles tendon pain is a common occurrence amongst the general population. Referred to as Achilles tendinopathy, the condition is associated with a combination of cellular changes affecting the Achilles tendon usually due to overuse and excessive chronic stress upon the tendon. 

 

The Achilles tendon is one of the biggest and strongest tendons in the body. The tendon has the capacity to resist huge forces (over 7 times your bodyweight when hopping!). It stems from the two main calf muscles (the gastrocnemius and soleus) and inserts at the bottom of the heel bone (calcaneus). Being synonymous with the calf muscles means that the Achilles tendon has a role in pushing off (walking, running, jumping, going up stairs, etc.), absorbing impact (going down stairs, landing, etc.) as well as store and release energy (repeated hops).

Achilles pain is often connected to sports activities, the biggest cause is the excessive overburdening of the tendon. The overburdening of the tendon is commonly seen in people doing too much, too soon. As physiotherapists, we often see this in people who are just getting into running and start with a training load that is too much for the body, as well as people who may be more experienced in activity but have ramped up their training load to build up to an event. Unfortunately, we also see Achilles tendon pain in the everyday population too.  

 

So what causes Achilles tendinopathy? Tendons are a tricky bunch, and the medical world is still learning a lot about them through research. Some commonly accepted risk factors to Achilles tendinopathy include:

 

  • Rapid changed to load
  • Type II Diabetes
  • Obesity
  • Prolonged steroid use
  • Inappropriate footwear 
  • Running style
  • Biomechanics

 

I think I fit the criteria of Achilles tendinopathy, what are the signs and symptoms?

As the name suggests, most of the pain is localised to the Achilles and heel region. Morning pain and stiffness is also a common symptom along with discomfort on stretching and compression of the tendon. Some people might notice some swelling or thickening around the tendon and the tendon being painful to touch.

 

Great! So how do I get better?! 

Tendons are slow to recover, and getting rid of the pain and making sure it stays gone will take months of commitment. The first step is identifying what is causing overload of the tendon, for some this might be training load and for others this might be a new job with more time on your feet. Once the external factors have been addressed then the biomechanical factors can be addressed, in the early stages this could mean taping of the foot or ankle, or getting some muscles stronger to share the load of the body. 

 

A few months to get better?! But I’m feeling pretty good now, can I start running? 

If all the risk factors, loads and strength/biomechanical deficits are addressed then the tendon may settle down within a few weeks, unfortunately this does not mean we can rush back into activity. A common pitfall is, surprise surprise, doing too much too soon (are you seeing a pattern here?) and sending things backwards. A typical progression of Achilles tendinopathy will depend on a person’s goals, but might look something like: 

 

  • Standing double leg heel raise
  • Standing double leg heel raise over step
  • Standing single leg heel raise
  • Lunge
  • Heel raise with increased speed
  • Jumping
  • Jumping different directions
  • Hopping
  • Run/walk program
  • Continuous low intensity running
  • High intensity running

 

The bottom line of Achilles tendinopathy:

  • Achilles tendons can get overloaded by an increase in load or a change in demands.
  • Pain and tenderness in the area is a common sign along with morning pain and possibly swelling.
  • Recovery will involve identifying and correcting risk factors and deficits.
  • Returning to goals must be slow and progressive to avoid flare-ups.

 

Blog by Luca Scomazzon-Rossi

Luca is physiotherapist here at Evolve Physio Group on St Kilda Road. Luca has experience treating Achilles tendinopathy to the Albert Park, South Yarra, Melbourne and Middle Park community.

References:

Achilles tendinopathy. (2022). Retrieved November 23, 2022, from https://www.physio-pedia.com/Achilles_Tendinopathy

Cook, J. L., & Purdam, C. R. (2008). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British Journal of Sports Medicine, 43(6), 409-416. doi:10.1136/bjsm.2008.051193

Järvinen, T. A., Kannus, P., Maffulli, N., & Khan, K. M. (2005). Achilles tendon disorders: Etiology and epidemiology. Foot and Ankle Clinics, 10(2), 255-266. doi:10.1016/j.fcl.2005.01.013

Luong, D. (2022, March 08). Achilles tendinopathy: Radiology reference article. Retrieved November 23, 2022, from https://radiopaedia.org/articles/achilles-tendinopathy

Paoloni, J. (2012). Current strategy in the treatment of achilles tendinopathy. Achilles Tendon. doi:10.5772/31222