What is Achilles Tendinopathy

Achilles tendinopathy (or tendonitis as more commonly and likely incorrectly called) is a condition which causes pain and discomfort at the Achilles tendon. The Achilles tendon connects the calf muscles (lower leg) to the heel boneTendonitis suggests that the problem is due to inflammation, however it is now thought this is unlikely and a “wear and tear” (degenerative process) is the involved.

This is a common condition which can impact upon sports, work and recreational and everyday activities. It on average takes approximately 3-6 months to resolve with treatment, but some cases, can take longer. 

What are the symptoms?
  • Pain located at the Achilles or into the back of the heel (not usually the sole of the heel)   Link to planar fascitis page 
  • Stiffness – particularly on a morning or after a long rest.  
  • Swelling – you may notice your achilles becoming visibly thicker  
  • Tender to touch 
What are the causes and risk factors?

There are many proposed risk factors and causes including: 

  • Sudden changes in activity level or exercise load eg walking or running more. 
  • Altered foot biomechanics – changes to footwear of the mechanics of the foot – eg flat feet  
  • Reduced ankle range of movement (particularly in dorsiflexion– pointing toes upwards) 
  • Reduced ankle strength  
  • Certain chronic diseases that affect tendon quality (e.g diabetes, rheumatoid arthritis) 
  • Being overweight – added weight and force through the tendon 
Diagnosis

Achilles tendinopathy is diagnosed from thorough history taking and physical examination. In the high  majority of cases there will be no need or benefit for any diagnostic imaging (e.g. X-ray or scans). 

 

Treatment options
  • Relative rest – ensure that you take a period of time to allow the initial flare of pain to settle before resuming activities or starting an exercise programme. 
  • Anti-inflammatory medication – these can be useful in the early stages however ensure you consult your pharmacist or GP regarding dose and possible side effects 
  • Footwear – ensure you are wearing supportive footwear as opposed to flat shoes which can worse pain.  
  • Insoles – Specific insoles after biomechanics assessment can be useful in some cases.  
  • Weight loss Pain relief – simple medication like paracetamol or ibuprofen can help reduce pain in early stages, to allow activity to aid weight loss. Cycling or swimming are ideal if weight bearing exercise is too painful. 

GraphWhilst Achilles tendonopathy is painful, rest alone is likely to only help ease the pain in the short term. “Loading exercises” are needed to trigger regeneration the worn tendon to prevent recurrence and allow return to normal activities. 

Training advice - for sportsmen and women

As Achilles tendinopathy is more commonly found in those who exercise, particularly runners; it accounts for approximately 9-15% of all running injuries. 

Below are some tips for adjusting training: 

  • Use cross training to vary your type of training eg swimming, cross trainer, rowing, cycling, pilates. 
  • When increasing training load try to stick to approximately 10% extra per week.  
  • Vary the speeds and distance of running  
  • Taking rest days 

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Please note -
These are general exercises, seek advice if you are unsure.

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