Achilles Injuries

The Achilles tendon is the large tendon at the back of the ankle. It attaches the calf muscle (gastrocnemius and soleus muscles) to the heel bone (calcaneus) and provides the power in the 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.

It can be either acute, meaning occurring over a period of a few days, or chronic which occurs over a longer period of time. The condition can be either at the attachment point to the heel or in the mid-portion of the tendon (typically around 6cm above the heel). Healing is often slow, due to its poor blood supply.

Symptoms of Achilles Tendinopathy

Acute Tendinosis:
Gradual onset of pain 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 tendinopathy may follow on from acute tendinosis if it goes untreated or is not allowed sufficient rest.

Chronic Tendinopathy:
Gradual onset of pain over a period of weeks, or even months.
Pain with all exercise, which is constant throughout.
Pain in the tendon when walking especially up hill or up stairs.
Pain and stiffness in the Achilles tendon especially in the morning or after rest.
There may be nodules or lumps in the Achilles tendon, particularly 2-4cm above the heel.
Tenderness on palpation.
Swelling or thickening over the Achilles tendon.
There may be redness over the skin.

Causes of Achilles Tendinopathy

• Increase in activity (either distance, speed or hills).

• Less recovery time between activities.

• Change of footwear or training surface.

• 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.

• 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.

What can you do?

Rest and apply cold therapy.
Wear a heel pad to raise the heel and take some of the strain off the Achilles tendon. This should only be a temporary measure while the Achilles ten- don is healing.
See a sports injury professional who can advise on treatment and rehabilitation.

What can we do?

If the Achilles tendinosis is acutely injured there may be inflammation present and therefore the use of anti-inflammatories may be appropriate. Taking fish oil tablets and drinking green tea are also good ways of reducing inflammation.
Identify predisposing factors such as biomechanical abnormalities, inappropriate training methods or strength deficits.
Prescribe a rehabilitation programme to appropriately load the tendon.
Apply manual therapy such as sports massage, mobilization of the tendon or taping techniques.
Use ultrasound treatment

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