What is Achilles Tendonitis?

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:

  • Acute - occurring over a period of a few days, following an increase in training.
  • Chronic - occurring 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.

Symptoms of Achilles Tendonitis

Acute achilles tendonitis: Gradual onset of achilles pain at the back of the ankle, just above the heel bone, which develops over a period of days. 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 there is not sufficient rest. Chronic achilles tendonitis is a difficult condition to treat, particularly in older athletes who appear to suffer more often.

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 such as:

  • Increase in activity (either distance, speed or hills).
  • Sudden increase in intensity
  • Less recovery time between activities.
  • Recent change of footwear or training surface.
  • Tight or Weak calf muscles.
  • Decreased range of motion at the ankle joint, usually caused 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. Overpronation 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

  • Rest and apply cold therapy.
  • Wear a heel pad to raise the heel and take some of the strain off the achilles tendon (temporary).
  • Find the right running shoes for your foot type and the sport.

Our sports therapy can include:

  • Identify the causes and get a prescribed custom orthotics or change in training methods.
  • Tape the back of the leg to support the tendon.
  • Apply a plaster cast if it is really bad.
  • Use ultrasound treatment.
  • Apply sports therapy techniques & prescribe a rehabilitation programme.

Preventing Achilles Tendonitis

Achilles tendon injuries occur during sports and can be prevented. If you had an Achilles tendon problem in the past, it is especially important to try to prevent another injury by:

  • Warming up and stretching. Before any sport or intense activity, gradually warm up your body by doing 5 to 10 minutes of walking or biking and then do stretching exercises. Calf stretches will stretch and strengthen the Achilles tendon and calf muscles. More general stretches target other muscles, such as the hamstrings and groin.
  • Cooling down and doing more stretching. After intense activity, gradually cool down with about 5 minutes of easy jogging, walking, or biking, and 5 minutes of stretches.
  • Avoiding any sport or intense activity that you are not in condition to do.
  • Wearing shoes that cushion your heel during sports or any strenuous activity.
  • Wearing heel pads or other orthotics that are designed to reduce stress on the Achilles tendon.

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 heel pain Achilles then it may become chronic which is very difficult to treat.