Achilles Tendonitis

What is Achilles Tendonitis?

It is estimated that 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 heal bone (calcaneus) and provides the power in the push off phase of the gait cycle. The achilles tendon can become inflamed through overuse as well as a number of contributory factors. The Achilles tendon has a poor blood supply which is why it is slow to heal.

Achilles tendoinitis can be acute or chronic. Acute achilles tendinotis may happen as a result of overuse or training too much, too soon especially on hard surfaces or up hills.

Symptoms of achilles tendonitis (tendinitis)

Symptoms for acute inflammation of the Achilles tendon are:

Pain on the tendon during exercise. Achilles pain will gradually come on with prolonged exercise but will go away with rest.
Swelling over the Achilles tendon.
Redness over the skin.
You can sometimes feel a creaking when you press your fingers into the tendon and move the foot.

Chronic achilles tendinitis may often follow on from acute achilles tendinitis if the acute tendon injury is not treated properly or allowed to heal. Chronic Achilles tendonitis is a difficult condition to treat, particularly in older athletes who appear to suffer more often. The pains experienced during the acute phase of the injury tend to disappear after a warm up but return when training has stopped. Eventually the injury gets worse and worse until it is impossible to run.

Symptoms for chronic Achilles tendonitis are similar to those of acute tendonitis as well as:

Pain and stiffness in the Achilles tendon especially in the morning. This pain may be described as diffuse along the tendon rather than specific.
There may nodules or lumps in the achilles tendon, particularly 2cm above the heel.
Pain in the tendon when walking especially up hill or up stairs.
Chronic tendonotis differs from acute tendinitis in that it is more of a long term persistent problem.

Causes of achilles tendinitis

Overuse. Too much too soon is the basic cause of overuse injuries, however other factors can make an overuse injury more likely.
Running up hills will mean 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 can place an increased strain on the achilles tendon. As the foot rolls in (flattens) the lower leg rotates inwards also which twists the achilles tendon place twisting stresses as well as stresses along its length.
Wearing high heels consistantly and then expecting to run 5 miles in flat running shoes puts abnormal strain on the achilles tendon making it stretch further than it is comfortable.

Treatment of achilles tendonitis (tendinitis)

What can the athlete do?

Rest and apply cold therapy or ice (not directly onto the skin).
Wear a heel pad to raise the heel and take some of the strain off the achilles tendon. This should be a temporary measure while the achilles tendon is healing.
See a sports injury professional who can advise on treatment and rehabilitation.

What can a Sports Injury Therapist or Doctor do?

Prescribe anti-inflammatory medication such as ibuprofen.
Identify the causes and prescribe orthotics or a 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 massage techniques.
Prescribe a rehabilitation programme.
Some might give a steroid injection however an injection directly into the tendon is not recommended. Some specialists believe this can increase the risk of a total rupture.
Scan with an MRI or Ultrasound - see latest research for more info.

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 this injury then it may become chronic which is very difficult to treat.

Products that may help (see right hand side of page):
(please consult your therapist before using any products to ensure they are compatible with your treatment programme)

Cold Therapy Wraps - can be wrapped around to apply cold and compression reducing pain and inflammation.
Arch Support Insoles - or orthotic type insoles which give firm support for the arch of the foot can help prevent over pronation and improve foot biomechanics. Overpronation of the foot causes the achilles tendon to twist, increasing the stress on it.
Slant Board - this is excellent for applying an accurate and gradual stretch to the calf muscles. It is easy to identify and difference in calf muscle flexibility when stretching both legs at once. Stretching can be progressively increased and a much greater degree of stretching is possible over achilles stretches on the floor.
Achilles tendon straps - this wraps around the ankle and applies gentlr pressure onto the achilles tendon. It works by reducing the shock and tension in the achilles tendon in the same was as a tennis elbow support works.
Heel Pads - can slightly raise the heels which temporarily shortens the calf muscles reducing stress on the achilles tendons. Also reduces shock which may also reduce stresses on the tendon.
Night Splint - is worn over night to apply a very gentle stretch and prevent tightening of the achilles tendon and plantar fascia. Mainly advertised as plantar fasciitis night splints they are also excellent for achilles / calf muscle flexibility.