Achilles tendonitis (tendinopathy) is a relatively common condition characterised by tissue damage and pain in the Achilles tendon. The muscle group at the back of the lower leg is called the calf which insert into the heel bone via the Achilles tendon. During contraction (use) of the calf, tension is placed through the Achilles tendon. When this tension is excessive due to too much repetition or high force, damage to the tendon occurs. Achilles tendonitis is a condition where there is damage to the tendon with subsequent degeneration and inflammation. This may occur traumatically due to a high force going through the tendon beyond what it can withstand or, more commonly, due to gradual wear and tear associated with overuse.
Achilles tendonitis most commonly occurs due to repetitive or prolonged activities placing strain on the Achilles tendon. This typically occurs due to excessive walking, running or jumping activities. Occasionally, it may occur suddenly due to a high force going through the Achilles tendon beyond what it can withstand. This may be due to a sudden acceleration or forceful jump. The condition may also occur following a calf or Achilles tear, following a poorly rehabilitated sprained ankle or in patients with poor foot biomechanics or inappropriate footwear. In athletes, this condition is commonly seen in running sports such as marathon, triathlon, football and athletics.
Patients with this condition typically experience pain in the region of the heel and back of the ankle. In less severe cases, patients may only experience an ache or stiffness in the Achilles region that increases with rest (typically at night or first thing in the morning) following activities which place stress on the Achilles tendon. These activities typically include walking or running excessively (especially uphill or on uneven surfaces), jumping, hopping, or performing heel raises (raising up on to the toes). The pain associated with this condition may improve with activity in the initial stages of injury. As the condition deteriorates, symptoms increase during sport or activity, affecting performance. Pain may also increase when performing a calf stretch or heel raise. In severe cases, patients may walk with a limp, be unable to weight bear on the affected leg or wake with night pain in the Achilles.
Patients with Achilles tendonitis may also experience swelling and tenderness on firmly touching the Achilles tendon, weakness and sometimes thickening of the affected Achilles tendon when compared with the unaffected side.
A thorough examination from a physiotherapist is usually sufficient to diagnose an Achilles injury such as Achilles tendonitis. Occasionally, further investigations such as an Ultrasound, X-ray or MRI scan may be required to assist with diagnosis and assess the severity of the condition.
Most patients with this condition heal well with appropriate physiotherapy. This, however, can be a lengthy process in those who have had their condition for a long period of time. Early physiotherapy treatment is vital to hasten recovery in all patients with this condition.
There are several factors which increase the likelihood of developing this condition. These need to be assessed and corrected with direction from a physiotherapist. Some of these factors include: joint stiffness (particularly the ankle), muscle tightness (particularly the calf), inappropriate or excessive training, poor biomechanics, poor foot posture (i.e. flat feet or high arches), inappropriate footwear, inadequate warm up, muscle weakness, poor proprioception or core stability and being overweight
Physiotherapy treatment for patients with an Achilles injury is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise: soft tissue massage, electrotherapy (e.g. ultrasound), the use of crutches, the use of heel wedges, stretches, joint mobilisation, ice, exercises to improve strength, flexibility, core stability and balance, education, anti-inflammatory advice, activity modification advice, hydrotherapy, biomechanical correction (e.g. the use of orthotics), footwear advice, a gradual return to activity program and a gradual return to running program.
If you are experiencing any of these symptoms, have any queries or would like to book an appointment speak to one of our friendly staff on 9716 2250.