Achilles tendinopathy is a common overuse injury characterised by pain and stiffness around the Achilles tendon with loss of function in activities such as walking, running and jumping. Onset is generally gradual, although pain may present quite suddenly after a sudden increase in loading.
Tendon injuries exists on a continuum and can either be acute and short-lived or when poorly managed, become chronic and degenerative, resulting in weakness of the tendon with more persistent pain and dysfunction. Achilles tendinopathy can occur in the mid-portion of the Achilles tendon, or in the insertion of the Achilles to the heel.
Several factors have been proposed to contribute to Achilles tendinopathy, including:
- Sudden increase in training volume or intensity.
- Poor footwear choice or a change of footwear may cause overload.
- Poor running or lower limb biomechanics.
- The use of fluroquinolone antibiotics.
- Decreased calf or lower limb strength.
- Poor biomechanics.
Diagnosis of Achilles tendinopathy by an experienced Physiotherapist is quite straight forward and while imaging can be performed it is generally unnecessary.
- Palpation of the tendon reproduces pain.
- Test designed to load the Achilles reproduce pain.
- Morning pain that ‘warms up’ to a degree is common.
- There is commonly a history of increased load in the leadup to the condition.
- There is often a visible ‘bump’ in the middle of tendon.
Management of Achilles tendinopathy is a multimodal approach and often includes:
- Education around the causes and management of tendinopathy.
- Activity modification to reduce load such as decreasing run distances or tracking daily step count.
- Graduated loading of the tendon with strength training and a slow progression back to explosive movements such as running.
- Correction of any abnormal biomechanics.
- Changes in footwear to a higher heel drop or insertion of heel lifts may help.
- Other adjuncts may include manual therapy, ice, pain medication or injections in some cases.
While a common and often disabling condition, with a concerted effort on rehabilitation and a shared decision making process between the client and physiotherapist, a significant improvement in symptoms and function should be possible.
If you are putting up with Achilles tendinopathy, book now with one of our experienced physiotherapists to create a plan to get you back In Balance and doing the things you love!