Achilles Tendinopathy
Achilles Tendinopathy refers to a condition characterised by pain and inflammation of the Achilles tendon, which is the large tendon located at the back of the ankle connecting the calf muscles to the heel bone. This condition is often the result of overuse, repetitive stress, or degeneration of the tendon. There are two main types of Achilles tendinopathy; insertional which presents with pain around the heel, and mid-portion which presents with pain along the body of the tendon.
Common causes include excess or sudden increases in physical activity, improper footwear, tight calf muscles, and biomechanical issues. Individuals engaging in activities that involve repetitive stress on the Achilles tendon, such as running or jumping, are more prone to developing this condition.
Common causes include excess or sudden increases in physical activity, improper footwear, tight calf muscles, and biomechanical issues. Individuals engaging in activities that involve repetitive stress on the Achilles tendon, such as running or jumping, are more prone to developing this condition.
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Pain and stiffness at the back of the heel in the morning or after a period of rest during the first steps once getting out of bed.An ache in the heel after running, walking, or climbing stairs.
Difficulty walking.
Swelling or tenderness along the Achilles tendon.
Treatments
Achilles tendinopathy is treated using a wide variety of methods, and your physiotherapist will be able to identify which treatments would be best for your symptoms.Exercise therapy is often the first treatment approach used to treat Achilles tendinopathy. The focus of exercise therapy is to provide progressive tendon-loading which initially promotes pain relief through isometric exercises, before facilitating strengthening of the tendon through eccentric and heavy slow resistance training [1]. Strengthening will predominately focus on strengthening the calf muscles. Stretching of the calf muscles has also been shown to reduce pain in individuals with Achilles tendinopathy [2]. Your physiotherapist may also apply tape around the Achilles tendon during the early stages to decrease the stress on the tendon and facilitate the recovery process [3].
Extracorporeal Shockwave Therapy (ESWT) has also been shown to provide significant improvements in symptoms for individuals with Achilles tendinopathy. ESWT is a non-invasive treatment which induces tissue healing by promoting the formation of new blood vessels [4]. Studies have reported that ESWT may provide similar benefits to exercise therapy for short term improvements, whilst combining ESWT with exercise produces significantly better outcomes compared to exercise alone [5,6].
If ankle biomechanics are deemed to be influencing or increasing the risk and symptoms of Achilles tendinopathy, then foot orthosis may also be recommended to correct ankle and foot kinematics and reduce pain [3].
References
1. von Rickenbach KJ, Borgstrom H, Tenforde A, Borg-Stein J, McInnis KC. Achilles tendinopathy: evaluation, rehabilitation, and prevention. Current sports medicine reports. 2021 Jun 1;20(6):327-34.2. Verrall G, Schofield S, Brustad T, Physio D. Chronic Achilles tendinopathy treated with eccentric stretching program. Foot & ankle international. 2011 Sep;32(9):843-9.
3. Martin RL, Chimenti R, Cuddeford T, Houck J, Matheson JW, McDonough CM, Paulseth S, Wukich DK, Carcia CR. Achilles pain, stiffness, and muscle power deficits: midportion Achilles tendinopathy revision 2018: clinical practice guidelines linked to the International Classification of Functioning, Disability and Health From the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2018 May;48(5):A1-38.
4. Covey CJ, Mulder MD. Plantar fasciitis: How best to treat. J Fam Pract. 2013 Sep 1;62(9):466-71.
5. Mani-Babu S, Morrissey D, Waugh C, Screen H, Barton C. The effectiveness of extracorporeal shock wave therapy in lower limb tendinopathy: a systematic review. The American journal of sports medicine. 2015 Mar;43(3):752-61.
6. Rhim HC, Kim MS, Choi S, Tenforde AS. Comparative efficacy and tolerability of nonsurgical therapies for the treatment of midportion Achilles tendinopathy: a systematic review with network meta-analysis. Orthopaedic Journal of Sports Medicine. 2020 Jul 15;8(7):2325967120930567.
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