Achilles tendinopathy
What is Achilles Tendinopathy?
Achilles tendinopathy is a common condition associated with overuse of the Achilles tendon, resulting in ankle pain, swelling and inflammation of the Achilles tendon sheath. Pain is localised 2-6 cm above the tendon's insertion onto the calcaneus
bone (heel bone), which is the attachment of the calf muscles (Gastrocnemius, Soleus
and Plantaris muscles).
What causes Achilles pain?
The Achilles tendon is the largest and strongest tendon in the human body. Tendinopathy
occurs when there is repetitive and excessive compression of the Achilles. This
can lead to acute/sudden overload injury resulting in Achilles pain when running, blunt trauma or acute muscle fatigue.
The muscles that are causing the issue are the calf muscles that attachment into the Achilles tendon (Gastrocnemius-Soleus-Plantaris).
Little tears in the calf muscles can lead to an inflammatory reaction resulting in pain. In addition, the tibiotalar joint (junction between lower leg and ankle) would be under a great deal of pressure. Increased foot pronation, as well as lack of flexibility or a stiff Achilles tendon can increase the risk of
these injuries. Due to the poor blood supply a slow healing rate may follow injury.
Clinical Presentation/characteristics
Ankle pain in the morning is a common symptom because the Achilles tendon must
tolerate full range of movement immediately after getting up. There is often pain when walking.
Swelling of the ankle and stiffness are also common.
Those suffering with this will have a sensitive zone, that increases in sensitivity under pressure.
Potential findings of examination
Pain is localised 2-6 cm proximal to the tendon's insertion.
Range of motion testing, strength and flexibility are often limited on the side
of the tendinopathy.
Palpation tends to elicit localised tenderness that is similar in quality and
location to the pain experienced during activity. Palpable nodules and
thickening are noticeable.
How to prevent Achilles pain?
Complete rest is not advised so patients should continue with their activity within their pain tolerance while participating in rehabilitation.
Eccentric strength training not only helps reduce tendon pain but modulate excitatory and inhibitory control of muscle, and thus potentially tendon load.
Manual therapy to the hip, knee, foot and ankle if evaluation reveals joint dysfunction and to mobilise restricted joints.
Medical acupuncture can also be used to inhibit pain.