Achilles tendinopathy

What is Achilles tendinopathy? Achilles tendinopathy is irritation, or degeneration of tissue of the Achilles tendon, causing pain in the heel or in the lower leg above the heel. The Achilles tendon connects the muscles in the back of the leg (lower calf) to the foot (at the heel) and is the largest tendon in the body. The injury can be acute or chronic and is most commonly seen in runners and athletes. Individuals with Achilles tendonitis may have a difficult time walking.

What causes Achilles tendinopathy? The primary cause of Achilles tendinosis is overusing the tendon, typically occurring when there is a sudden increase in the frequency or intensity of an exercise. Other causes that can contribute to Achilles tendinosis are related to situations that stress the Achilles tendon, such as overpronation of the feet, weak or tight calf muscles, wearing high heels often but then exercising in flat shoes, changes in training surfaces or inclines, or not allowing the body sufficient rest between exercising. Improper conditioning or activities that repeatedly stress the tendon (such as jumping or quick stops and starts) can also contribute to the condition.

What are the symptoms of Achilles tendinosis? Achilles tendinopathy can either be an acute or chronic condition. In acute Achilles tendinosis, there is a gradual onset of pain in the heel or above the heel over the course of a few days that is apparent when exercise or movement is begun, or when pushing off on your foot or rising on your toes. Pain typically diminishes as exercise continues or when the foot is at rest. There is also tenderness when pressing on the tendon. With chronic Achilles tendinosis, the pain gradually develops over a much longer term and the pain remains constant throughout all types of movement or exercise. Chronic conditions may also cause swelling or redness in the area of the tendon in addition to tenderness, and the individual may feel pain and stiffness in the tendon when at rest. A creaking sound may also be noted when moving or touching the tendon.

How is Achilles tendinopathy diagnosed? A medical professional will take a thorough medical history and ask patients about what they were doing prior to the pain beginning. Visual inspection of the feet and lower legs will occur, as well as a manual inspection, testing for tenderness, swelling or creaking. Active and passive range of motion will be assessed at the ankle in comparison with the other side. Real time ultrasound may be recommended to fully diagnose the extent of an injury.

When should I seek care for Achilles tendinopathy? If you are unable to walk, bend your foot downward or rise on your toes, or experience sudden and severe pain, you may have ruptured your Achilles tendon and should seek immediate medical care. Otherwise, if rest do not alleviate your pain and discomfort, you have decreased range of motion, or the pain worsens, you should a physiotherapist. Failing to treat acute Achilles tendinosis can turn into a chronic condition that is very difficult to treat.

What will the treatment for Achilles tendinopathy consist of? The first course of treatment for Achilles tendinopathy is rest. Changes may need to be made in the type of footwear worn, or shoe inserts (orthotics) may help by elevating your heel to reduce some of the strain on the Achilles tendon. If rest do not alleviate the pain caused by Achilles tendonitis, a course of physical rehabilitation, ultrasound guided EPI, may be prescribed. In some cases, a cast or walking boot and crutches may be needed to allow the tendon to heal properly. Surgery is usually a last resort option.

Which muscle groups/ joints are commonly affected from Achilles tendinopathy? The Achilles tendon runs along the lower leg (the back of the calf), connecting to the foot at the heel. Achilles tendinopathy primarily affects the back of the ankle.

What type of results should I expect from the treatment of Achilles tendinopathy? Acute Achilles tendinosis is easily treatable if proper rest is allowed and rehabilitation followed if warranted. If left untreated, acute conditions can turn into chronic Achilles tendonitis or an Achilles tendon rupture, which is difficult to treat or may require surgery.