Achilles tendonitis (also known as Achilles tendinopathy or Achilles tendinosis) is an overuse injury causing pain, inflammation and or degeneration of the Achilles tendon at the back of the ankle.
If not caught early this can be a difficult injury to cure but with the right treatment and particularly eccentric strengthening exercises a full recovery can usually be achieved.
Symptoms consist of pain and stiffness at the back of the ankle which may have come on gradually over time and often be worse first thing in the morning. Achilles tendonitis can be either acute or chronic. Acute tendonitis is usually more painful and of recent onset.
Chronic injuries will have come on gradually and over weeks or may follow an acute injury that is not treated properly. Chronic injuries do not not necessarily prevent activity but can niggle away affecting performance. The VISA achilles tendon pain questionnaire has been designed to measure symptoms during rehabilitation. An MRI or Ultrasound scan can determine the extent of the injury and indicate a precise diagnosis.
Read more on Achilles symptoms and diagnosis.
What is Achilles tendinitis?
The Achilles tendon is the large tendon at the back of the ankle. It connects the big calf muscles at the back of the lower leg to the foot and inserts at the back of the heel or calcaneus bone. It provides the power in the push off phase of walking and running where huge forces are transmitted through the Achilles tendon. Achilles tendonitis is usually an overuse injury caused by doing too much too soon.
Strictly speaking the term tendonitis suggests an inflammatory condition of the tendon but in reality few injuries are actually down to pure inflammation. The main finding, particularly in older athletes is usually degeneration of the tendon. The term Achilles tendinopathy is probably a better term to describe the range of conditions that can cause Achilles tendon pain.
Although overuse is the primary cause, there are a number of factors which can increase your risk of sustaining the injury including poor footwear, soft training surfaces, tight muscles and foot biomechanics and running uphill.
Read more on causes and prevention.
Achilles Tendonitis Treatment
For an acute injury applying ice for 10 minutes every hour or so reducing frequency as required for the first 2 to 3 days can help reduce pain and inflammation. Rest is important so try to stay off your feet as much as possible. Wearing a heal lift or heel pad (in both shoes) can help reduce the strain on the tendon by shortening the calf muscle very slightly, although this should only be done as a short term measure. A simple Achilles tendon taping technique can be used to take the strain off a painful Achilles tendon allowing it to rest more easily, especially if you have to be on your feet.
A long term chronic Achilles tendon injury may respond better to application of heat, again applied for 10 minutes every couple of hours as required. Applying gentle self massage to the achilles tendon may also be beneficial. If Achilles tendonitis has been a persistent problem then the Hakan Alfredson's heel drop protocol exercises have been shown to be effective in up to 90% of patients. They involve performing a heel drop exercises 180 times every day for 12 weeks during which time pain may actually get worse before it gets better.
Gentle calf stretching exercises can help stretch the muscles and aid recovery. A plantar fasciitis night splint is worn in bed and is excellent for preventing calf muscles tightening up over night.
A professional practitioner or Doctor may prescribe anti-inflammatory medication such as ibuprofen which might help with acute Achilles inflammation and pain but has not been proven to be beneficial long term and may even inhibit healing. Application of electrotherapy such as ultrasound can also help reduce pain and inflammation and sports massage can help mobilize the tissues of the tendon and relax the calf muscles. They can also identify possible causes such as biomechanical problems with the foot which may be contributing to the chance of injury.
Read more on treatment and rehabilitation.
The Hakan Alfredson's heel drop protocol exercises have been shown to be effective in up to 90% of patients suffering with Achilles tendon pain and involve the patient dropping the heel to horizontal in a slow and controlled manner.
The athlete performs an eccentric heel drop exercise on a step going up with both legs and slowly lowering the heel to the horizontal position. Eccentric exercises are those where the muscles (in this case the calf muscles) get longer as they contract. Exercises are performed twice a day to a total of 180 repetitions and continued for 12 weeks. Pain may often get worse over the 12 weeks before it starts to get better.
Read more on Achilles tendon heel drop exercises.
We have a number of resources to help in the recovery of Achilles tendonitis including our 12 week exercise check sheet and our downloadable VISA Achilles pain questionnaire which is a great way to monitor how bad your injury is.
Download free Achilles tendonitis exercise record sheet (pdf)