Achilles Tendon Pain

ACHILLES TENDINOPATHY IS A BROAD TERM THAT COVERS PAINFUL CONDITIONS THAT CAUSE DAMAGE TO THE ACHILLES TENDON (A LOSS OF NORMAL FIBRE STRUCTURE).

THE TWO MAIN AREAS OF DAMAGE ARE THE MID PORTION OF THE TENDON AND THE INSERTION. THE CAUSE, SYMPTOMS AND TREATMENT OF EACH PRESENTATION DIFFER.

Midportion Symptoms

Pain in the Achilles tendon that can be of sudden or gradual onset. Severity of the pain is widely varied causing minimal to severe disability. With clinical assessment, pain is commonly felt with palpation or squeezing the Achilles approximately halfway up the tendon.

Insertional Symptoms

Pain is located at the base of the posterior heel- due to the close relationship between the insertion of the tendon, the bursa at the back of the heel and the heel bone itself. There may be a bony prominence and inflammation at the site.

Achilles Tendinitis Causes

Injury of the Achilles tendon occurs when the load applied to the tendon exceeds its capacity. This may occur in a single episode or over a period of time i.e. with overuse. Latest research suggests the tissue thickens when damaged, rather than becoming inflamed; however inflammation of surrounding structures may occur, particularly with insertional tendinopathy.

Common causes of overuse in the Achilles tendon may include:

● a return to running after a break
● increases in training or activity (speed, distance and gradient)
● decreased recovery time between runs
● Inefficient foot mechanics
● running on a cambered surface
● soft footwear
● calf muscle weakness

Midportion Treatment

The focus of treatment for midportion Achilles tendinopathy is to strengthen the tendon and to promote healing, after an initial period of de-loading. The following may be prescribed by a podiatrist:

Activity modification
Anti-inflammatory gels (‘night wrap’)
Strength exercises
Shock wave therapy *hyperlink to shock wave page
Orthotics to reduce load on the Achilles
Injections therapies
Surgery

Insertional Treatment

Isolated treatment for insertional Achilles tendinopathy is less successful than for mid portion tendinopathy. However, combined exercises and injections may be useful.

Treatment for insertional Achilles tendon should focus on unloading the region. This may be achieved by wearing heel lifts and/ or with the use of orthotics. Night splints may also be used to maintain the ankle at 90 degrees during sleep.

Other treatment may focus on symptoms arising from the retrocalcaneal bursa, including:

Non-steroidal anti-inflammatory medication
Cortisone injections into the bursa
Surgery in the presence of a Haglund’s deformity or bursitis when conservative measures fail

Shock wave therapy can also help to decrease pain and to promote healing in select cases of insertional Achilles tendinopathy.