The Achilles tendon, located at the back of the ankle, is the thickest and strongest tendon in the body. The tendon is an extension of the calf muscles (gastrocnemius and soleus) and it attaches to the heel (calcaneus). When the calf muscles contract the foot is pushed in a downward direction. This allows for push-off in walking, running, jumping and standing on the toes. Each Achilles tendon is subject to a person’s entire body weight with each step and during a sprint or push off this can be significantly increased.
A common disorder of the Achilles tendon is tendinosis. This describes a condition in which the tendon’s normal structure is compromised and some degenerative changes are generally present. Pain, swelling and restricted activity occur as a result of these changes.
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Achilles tendinosis is usually caused by overuse or overloading of the calf muscles. Several factors could increase a person’s risk of developing this condition by placing excessive force on the Achilles. These include:
- A recent or sudden increase in intensity, frequency and duration of the activity, particularly those involving running and jumping
- Change of training surface or running on hard or uneven surfaces, including hills
- Inadequate or reduced rest periods between activity
- Inappropriate, or change of, footwear
- Poor biomechanics of the foot (ie. High or low arches)
- Tightness or weakness in the calf muscles
- Ankle stiffness
Achilles tendinosis can be either acute (occurring over a period of a few days, following an increase in training) or chronic (gradual onset over a prolonged period). If an acute episode goes untreated it may develop into chronic Achilles tendinosis, which is much more difficult to treat. Patients presenting with Tennis Elbow will have a very typical presentation including one or multiple of:
- Pain at the back of the ankle, just above the heel bone where the Achilles tendon inserts
- Pain and stiffness in the morning or following a period of rest
- Pain with exercise, particularly with sprinting, which may or may not reduce once warmed up. In chronic cases, the pain is more likely to persist
- Stiffness of the tendon and discomfort with calf muscle stretches
- Tenderness on palpation and swelling or thickening of the tendon
- Impaired strength and movement of the affected leg
Initially, treatment is aimed at managing pain and reducing any further damage to the tendon. Seeking treatment or advice early is extremely important and will result in a reduced time to recover from injury and return to activity.
Treatment may include resting from aggravating activities, ultrasound, shockwave therapy, dry needling acupuncture, taping and custom orthotics. The underlying cause of the injury will also be addressed with an individualised rehabilitation program consisting of stretching and strengthening.
If managed promptly and properly, Achilles tendinosis should resolve after 4-6 weeks. If, however, the injury is left and treatment is not sought early, further tendon damage or a tendon tear may result and recovery can take months.