If you have ever suffered with a painful achilles, you will know how debilitating it is. You use the achilles tendon to walk, run, jump and stand on tiptoe. When the achilles tendon is inflamed or injured it can make doing any of these physical activities painful and difficult.

It’s not until something goes wrong with your achilles tendon that you realise just how important it is for physical function and carrying out simple everyday activities.

So, what exactly is achilles tendinopathy? What causes it? How is it diagnosed? And what are the treatment options? This article tells you everything you need to know about achilles tendinopathy and how to get better.

What is the achilles tendon?

The achilles tendon is the band of tissue that runs from the bone in your heel (calcaneus) to the calf muscle. It is the largest tendon in the body and is sometimes known as the calcaneal tendon. It is made up from bundles of fibres of collagen and connects with the calf muscles (gastrocnemius and soleus muscles) at the low end of the calf from the heel bone.

Tendons help bones to move when muscles contract, so the achilles tendon helps to move the heel and enables you to stand on tiptoe and walk, run or climb.

For further information about the achilles tendon, see the British Orthopaedic Foot & Ankle Society FAQ page here.

What is achilles tendinopathy?

Achilles tendinopathy is injury to the achilles tendon. It can make it hard for you to walk. Achilles tendinopathy usually occurs through a specific injury or from overuse.

What are the symptoms of achilles tendinopathy?

Common symptoms associated with achilles tendinopathy are:

  • Pain and swelling of the achilles (there is sometimes a prominent lump within the tendon)
  • Stiffness, usually at the back of the ankle (especially on rising in the morning)
  • Redness and warmth over the site of the achilles
  • Tenderness (the achilles is painful when gently squeezed)
  • Variable pain, which can prevent exercise or ease with exercise
  • Reduced range of motion in the ankle
  • Reduced strength in the lower leg

What are the most common causes of injury to the achilles tendon?

Injury is most commonly caused by overuse. When overused, small tears develop in the achilles. Without treatment the tears won’t heal and the tendon can become weaker.

Anyone can hurt their achilles, but some people are more prone to problems than others. Older people are more likely to suffer injury simply because muscles and tendons becomes less flexible with age. People who play sports are also more prone to injury.

Sometimes the exact cause of achilles tendinopathy isn’t easily established, but it generally occurs when the tendon is unable to adapt to the strain being placed upon it.

Factors that increase the risk of achilles problems include:

  • A sudden change in the intensity of any exercise schedule
  • Excessive training or exercising without a warm-up
  • A change of sports surface or footwear
  • Poorly fitting shoes
  • Playing sports that require quick stops and a sudden change of direction
  • Increasing age
  • High arches
  • Flat feet or excessive pronation (foot rolling inwards)
  • Ankle instability
  • Wearing high heels regularly
  • Tight hamstrings or calf muscles or straining the calf muscles through exercise
  • Having bone spurs at the back of your heels
  • Hill running

What is the difference between tendonitis, tendinosis and tendinopathy?

These terms describe a variety of tendon conditions and are not all the same thing. Tendonitis describes inflammation of the tendon. Symptoms include localised pain, swelling, redness and the area can feel warm to touch.

Tendinosis describes the non-inflammatory degeneration of a tendon. It may include changes to the structure and composition of a tendon. Tendinosis occurs when there have been repeated micro-traumas or when a ruptured tendon fails to heal.

Tendinopathy is an umbrella term used to cover any problem with a tendon. Although some medics use the term to describe a chronic tendon condition that is failing to heal. For the purpose of this article, the term achilles tendinopathy is used to cover any achilles problem.

How are achilles problems diagnosed?

Achilles problems can be diagnosed by a physiotherapist or foot and ankle specialist, such as a podiatrist. A physio or podiatrist will consider your history, symptoms and use clinical tests to confirm a diagnosis of achilles tendinopathy.

Your health practitioner may use diagnostic ultrasound to confirm the diagnosis and to see the extent of any damage or tears.

What is the treatment for achilles tendinopathy?

Treatment options include:

  • Ice to reduce inflammation
  • Rest (you can usually still swim or cycle as these don’t put strain on the achilles)
  • Stretching the calf muscle
  • Using a foam roller to massage the calf muscle
  • Using a tennis ball to release tension in the sole of the foot
  • Controlled exercises, such as calf stretches and tendon strengthening and lengthening

Your health practitioner (physio or podiatrist) will likely recommend a combination of ice, rest and eccentric strengthening exercises.

It an take 3-6 months of eccentric strengthening to get better.

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