Achilles Tendonitis

What is it?

The achilles tendon connects the calf muscles (gastrocnenius and soleus) to the back of the heel bone.  It is approximately 2cm wide and 15cm long and it is the strongest tendon in the body.  This tendon works to raise you up on tip toes and pushes you forwards when you walk or run.  It can usually withstand very high loads when landing from jumps or running.  The tendon has a relatively poor blood supply near its base and is vulnerable to microtears and gradual degeneration as its ability to withstand loading reduces over time.  Achilles tendonitis is characterised by pain and stiffness in the tendon especially first thing in the morning.  Acute tenderness can be felt approximately 2cm from its base and this may be associated with some nodular thickening.

Causes

Achilles tendonitis can either develop gradually and progress over time or suddenly as a result of a particular incident such as twisting the ankle. There are many factors which are thought to contribute to the development of achilles tendonitis some of which are listed below:

• Poor / worn footwear leading to reduced stability and control of the foot which causes an increased strain on the tendon

• Deconditioned, weak / tight calf muscles, or perhaps a history of an old calf strain which has not resolved fully

• Biomechanical problems i.e. overpronation of the foot

• Years of repetitive high loading i.e. running

• New or uncharacteristic training activities i.e. commencement of hill running rather than running on the flat or perhaps increasing the distance or speed of running  too quickly.

   

Treatment

Following a thorough examination and assessment of the presenting problem, advice and treatment may include the following: 

• Ice to reduce pain, swelling and inflammation

• Electrotherapy i.e. Ultrasound, Laser and Interferential therapy to control inflammation and pain

• Acupuncture for pain relief and restoration of normal muscle tone

• Heel raises and/or taping to offload injuried tissues and promote rest

• Advice regarding activity modification or changes to training

• Soft tissue and joint manipulation to address muscle tightness / joint restrictions which may have contributed to the development of the condition

• Addressing biomechanical or anatomical factors by using orthotics to restore correct foot alignment

• Exercise rehabilitation programme tailored to the individuals specfic needs to include stretching, strengthening and proprioceptive retraining