Achilles Tendonitis is an overuse injury causing pain on the achilles tendon. The achilles tendon is the thick, strong tendon at the back of the ankle. Achilles tendonitis can be difficult to cure and it is important the correct treatment methods are followed.
The term achilles tendinopathy is probably a better term to describe the range of conditions that can cause achilles tendon pain. Other common achilles tendon injuries include achilles tendinosis and achilles tenosynovitis. All of these conditions have very similar symptoms and are almost impossible to distinguish between without a scan, but they usually respond well to the same treatment.
Achilles Tendonitis Symptoms
Achilles tendonitis can be either acute or chronic. An acute injury is usually a more painful injury preventing the athlete from running and will have been noticed more recently. A chronic achilles tendonitis may come on over weeks and niggle away, not necessarily preventing activity.
Acute achilles tendonitis symptoms:
A gradual onset of achilles pain at the back of the ankle, just above the heel bone. This may develop over a period of days.
Achilles tendon pain at the start of exercise which fades as the exercise progresses and the tendon gets warmed up. The pain may later return if the training session is prolonged
The pain eases with rest but is often worse again in the morning.
The achilles tendon will be very tender on palpation or pressing in on the achilles tendon or squeezing it from the sides.
Chronic achilles tendonitis may follow on from acute achilles tendonitis if it goes untreated or is not allowed sufficient rest. Chronic achilles tendonitis is a difficult condition to treat, particularly in older athletes who appear to suffer more often.
Chronic achilles tendonitis symptoms:
A gradual onset of achilles tendon pain over a period of weeks, or even months.
Pain will come on during exercise and is constant throughout.
Pain will be felt in the achilles tendon when walking especially up hill or up stairs. This is because the achilles is having to stretch further than normal.
There is likely to be stiffness in the Achilles tendon especially in the morning or after a long period of rest. This is thought to be due to adhesions between the tendon sheath and the tendon itself.
There may be nodules or lumps in the achilles tendon, particularly 2-4cm above the heel. There may be redness over the skin.
Again there will be tenderness on palpation or pressing in on the achilles tendon. As well as a swelling or thickening over the Achilles tendon.
A creaking sensation may be felt when press the fingers into the sides of the tendon and moving the ankle.This is known as crepitus.
What is Achilles Tendonitis?
Achilles tendonitis is one of the most common 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 heel bone (calcaneus) and provides the power in the push off phase of the gait cycle (walking and running). Huge forces are transmitted through the achilles tendon when running and jumping.
Achilles tendonitis is often now being referred to as achilles tendinopathy. This is because the term tendinopathy covers all types of overuse achilles tendon injury. Strictly speaking tendonitis suggests an inflammatory condition of the tendon but in reality few achilles tendon injuries are actually down to inflammation. The main finding is usually degeneration of the tissue, particularly in old athletes, with a loss of normal fibre structure. Other very similar conditions may actually be due to inflammation or degeneration of the tendon sheath rather than the achilles tendon itself.
Achilles tendonitis can be either acute, meaning occurring over a period of a few days, following an increase in training, or chronic which occurs over a longer period of time. In addition to being either chronic or acute, the condition can also be either at the attachment point to the heel or in the mid-portion of the tendon (typically around 4cm above the heel). Healing of the achilles tendon is often slow, due to its poor blood supply.
Causes of Achilles Tendonitis
Achilles tendonitis is an overuse injury. Too much too soon is the common cause of overuse injuries, however other factors can contribute to developing the condition.
An increase in activity, either distance, speed or a sudden change to running up hills. As a rule of thumb distance runners should increase their mileage by no more than 10% per week.
A change of footwear or training surface for example suddenly running on soft sand can cause the heel to drop lower than normal making the tendon stretch further than it is used to.
Weak calf muscles can tighten or go into partial spasm which again increases the strain on the achilles tendon by shortening the muscle.
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. As the foot rolls in (flattens) the lower leg also rotates inwards which places twisting stresses on the 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.
Achilles Tendonitis treatment
Treatment for achilles tendonitis is based around initially reducing pain and inflammation, stretching the muscles out and a gradual return to activity. No one single thing may cure achilles tendonitis, particularly a chronic condition but a combination of treatment approaches and patience can work. It is essential the correct treatment is started as soon as possible in the acute stage to avoid the injury becoming chronic.
What can the athlete do to treat Achilles pain?
Self help achilles tendon treatment includes the following:
Rest and apply cold therapy. Applying ice or cold therapy as soon as possible will reduce pain and inflammation. Rest is vital to allow healing to take place. If you don't rest then the achilles tendonitis is likely to become chronic.
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 tendon is healing.
An achilles tendon taping technique can aid rest by supporting the tendon with elastic bandages. This is an excellent way of taking the load off the tendon if you have to walk around on your feet as well as protecting the tendon when returning to full fitness.
Make sure you have the right running shoes for your foot type and the sport. If you are a runner that over-pronates then a motion control or support running shoe may be needed. Visit a specialist running shop for advice.
In the later stages apply heat, especially before exercise. The tendon will perform better when warm. Finish with cold after training to reduce any inflammation.
See a sports injury professional who can advise on treatment and rehabilitation.
Scan with an MRI or Ultrasound scan to determine the extent of the injury and get a precise diagnosis.
Prescribe anti-inflammatory medication such as ibuprofen which may help with achilles pain - always check with a doctor before taking any medication.
Identify the causes and prescribe orthotics or a change in training methods. A podiatrist can advise on gait analysis and running shoes as well as prescribe orthotic insoles to correct biomechanical problems of the foot.
Apply a plaster cast if it is really bad. This will enforce rest allowing the achilles tendon to heal.
Use electrotherapy such as ultrasound treatment and laser therapy to reduce pain and inflammation and encourage healing.
Apply sports massage techniques. Massage can mobilze the tissues and help stretch the calf muscles.
Achilles tendonitis surgery may be performed if conservative treatment fails.
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.