The Achilles tendon is located at the back of your ankle and connects your two calf muscles to the bone in the heel of your foot. The tendon is made up of many collagen fibres. There are several ways in which the tendon can become injured, leading to Achilles tendinopathy. The tissue surrounding the tendon may become inflamed, the tendon may become worn down (degenerate), cysts (small sacs of fluid) may form inside the tendon, or tiny tears may form in the fibres.
Achilles tendinopathy is a commonly caused by overloading the tissue, and is often observed in sports that involve running and jumping. Repeated stress on the tendon causes microscopic damage to occur. Risk factors for developing Achilles tendinopathy include:
- Increasing your activity levels (mileage, speed, type of activity)
- Inadequate recovery time between training sessions
- A change in the usual training surface
- Wearing inappropriate footwear
- Poor biomechanics and the foot/ lower limb and pelvis
Symptoms:
The main symptoms of Achilles tendinopathy are increasing pain and stiffness, usually at the back of your ankle. You may also notice some swelling. This is sometimes called tendonitis.
Your Achilles tendon might feel tender when you touch it. There may be a grating noise or creaking feeling (crepitus) when you move your ankle.
The pain can come and go. It may be worse first thing in the morning or after you’ve done any exercise or activity. Your Achilles tendon may feel particularly stiff when you first get up or if you haven’t moved for a while. The stiffness may ease off when you start moving again.
Diagnosis:
Our clinicians will ask you about your symptoms and examine your leg, heel and ankle. A series of movements or exercises will help us to see how well you can move your lower limb. We will look to identify potential causes and determine the likely stage of the pathology. We will also ask you about your medical history and rule out other causes or conditions.
In some cases an ultrasound scan may be used to confirm if there are tears in your Achilles tendon. But often scans aren’t necessary for a diagnosis.
Treatment:
The core treatment strategy in Achilles tendinopathy is improving the load capacity of the muscle-tendon unit, we often have to reduce pain first to achieve this. Your clinician will consider the volume, intensity, frequency and type of training that you are undertaking, offering practical changes where required. In addition, you will undertake a rehabilitation program designed to improve the loading capacity of the tendon tissue. Depending on the stage of the pathology you may begin with isometric exercises, progressing to isotonic and plyometric movement. The goal of treatment is to allow you to maintain optimal tendon health.
Adjuncts such as Shockwave Ultrasound therapy and injection therapies may be considered to optimise healing and decrease pain when necessary.
