Achilles Tendonitis

Achilles Tendonitis or Achilles Tendinosis is a common cause of achilles pain at the back of the ankle. We look at why this happens and what treatment methods are available.

Symptoms of Achilles Tendonitis

Acute achilles tendon injury:

  • Gradual onset of achilles pain at the back of the ankle, just above the heel bone.
  • This develops over a period of days.
  • Achilles pain at the onset of exercise which fades as the exercise progresses.
  • Pain eases with rest.
  • Tenderness on palpation.

Chronic achilles tendonitis may follow on from acute tendonitis if it goes untreated or is not allowed sufficient rest. Chronic achilles tendonitis is a difficult condition to treat, particularly in older athletes who appear to suffer more often.

Chronic achilles tendonitis:

  • Gradual onset of achilles pain over a period of weeks, or even months.
  • Pain with all exercise, which is constant throughout.
  • Pain in the tendon when walking especially uphill or up stairs.
  • Pain and stiffness in the Achilles tendon especially in the morning or after rest.
  • There may be nodules or lumps in the achilles tendon, particularly 2-4cm above the heel.
  • Tenderness on palpation.
  • Swelling or thickening over the Achilles tendon.
  • There may be redness over the skin.
  • You can sometimes feel a creaking when you press your fingers into the tendon and move the ankle.

What is Achilles Tendonitis?

It is estimated that achilles tendonitis accounts for around 11% of all running injuries. The Achilles tendon is the large tendon at the back of the ankle. It connects the large calf muscles (Gastrocnemius and Soleus) to the heel bone (calcaneus) and provides the power in the push off phase of the gait cycle (walking and running).

Achilles tendonitis is often now being referred to as achilles tendinopathy. This is because it is no longer thought to be an inflammatory condition. On investigation, the main finding is usually degenerated tissue with a loss of normal fibre structure.

Achilles tendonitis can be either acute, meaning occurring over a period of a few days, following an increase in training, or chronic which occurs over a longer period of time. In addition to being either chronic or acute, the condition can also be either at the attachment point to the heel or in the mid-portion of the tendon (typically around 4cm above the heel). Healing of the achilles tendon is often slow, due to its poor blood supply.

Causes of Achilles Tendonitis

Achilles tendonitis is an overuse injury. Too much too soon is the basic cause of overuse injuries, however other factors can contribute to developing the condition.

  • Increase in activity (either distance, speed or hills).
  • Less recovery time between activities.
  • Change of footwear or training surface.
  • Weak calf muscles.
  • Decreased range of motion at the ankle joint, usually cause by tight calf muscles.
  • Running up hills – the achilles tendon has to stretch more than normal on every stride. This is fine for a while but will mean the tendon will fatigue sooner than normal.
  • or feet which roll in when running can place an increased strain on the achilles tendon. As the foot rolls in (flattens) the lower leg also rotates inwards which places twisting stresses on the tendon.
  • Wearing high heels constantly shortens the tendon and calf muscles. When exercising in flat running shoes, the tendon is stretched beyond its normal range which places an ‘abnormal’ strain on the tendon.

Treatment of Achilles Tendonitis

What can the athlete do to treat Achilles pain?

  • Rest and apply cold therapy.
  • Wear a heel pad to raise the heel and take some of the strain off the achilles tendon. This should only be a temporary measure while the achilles tendon is healing.
  • Make sure you have the right running shoes for your foot type and the sport.
  • See a sports injury professional who can advise on treatment and rehabilitation.

What can a Sports Injury Therapist or Doctor do?

  • Scan with an MRI or Ultrasound scan.
  • Prescribe anti-inflammatory medication such as ibuprofen which may help with achilles pain – always check with a doctor before taking any medication.
  • Identify the causes and prescribe orthotics or a change in training methods.
  • Apply a plaster cast if it is really bad.
  • Use ultrasound treatment.
  • Apply sports massage techniques.
  • Prescribe a rehabilitation programme.
  • Some might give a steroid injection however an injection directly into the tendon is not recommended. Some specialists believe this can increase the risk of a total rupture.
  • Use Extracorporeal Shock Wave Therapy (ESWT)
  • Achilles tendonitis surgery may be performed if conservative treatment fails.

If you look after this injury early enough you should make a good recovery. It is important you rehabilitate the tendon properly after it has recovered or the injury will return. If you ignore the early warning signs and do not look after this injury then it may become chronic which is very difficult to treat.