What is Achilles Tendinopathy?
Achilles tendinopathy is a common injury that occurs in the heel usually because of chronic stress or overuse of the tendon. It is most commonly seen in athletes but can happen in day-to-day life with any subtle changes in activity levels. It isn’t always but is sometimes related to a tear in the tendon.
The Achilles tendon is the biggest and strongest tendon in the body and has the ability to resist large tensile forces. It originates from the base of the gastrocnemius and soleus (calf muscles) and inserts into the bottom of the calcaneus (heel bone).
There are 2 forms of Achilles tendinopathies, these are insertional or mid-portion. These are diagnosed based on the location of the injury. The mid-portion form is in the tendon body, more than 2cm above the bony insertion. Whereas the insertional form is formed at the transition of the tendon to the bone.
It must be noted that this condition is usually not as a result of direct trauma to the achilles.
Risk factors:
The largest risk factors for developing Achilles tendinopathies are a lack of flexibility and stiffness of the tendon.
Some other risk factors related to developing Achilles Tendinopathy are:
- Obesity
- High blood pressure
- Rapid changed to load
- Type II Diabetes
- Prolonged steroid use
- Family history of tendinopathy
- Inappropriate footwear
- Eldery population
Signs and Symptoms:
The most common symptom of Achilles tendinopathy is morning pain, this is because the tendon must cope with a full range of motion including stretch immediately after complete rest whilst you have been asleep.
Other symptoms include:
- Pain and stiffness along the Achilles tendon in the morning
- Pain along the tendon or back of the heel that worsens with activity.
- Severe pain the day after exercising.
- Thickening of the tendon.
- Bone spur formation (insertional tendinopathy).
- Pain on the back of the heal when you wear shoes.
Common signs your physiotherapist will look for:
- Swelling along the Achilles tendon or at the back of your heel.
- Bone spurs or pain near the lower part of the tendon at the back of your heel (insertional tendinopathy).
- Pain in the middle of the tendon, (mid-portion tendinopathy)
- Heel pain when stretching your calf.
- Limited range of motion in your ankle.
Treatment – How can a Physiotherapist help you?
- Massage and dry needling
- ESWT: Shockwave therapy
- Lightforce – High powered laser therapy
- Taping
- Exercises: A home or gym-based program of progressive strengthening of your calf, foot and leg muscles, stretching, and eventually spring loading and return to sport exercises.
- Advice and education on load management strategies specific to you.
- Orthotics – for some patients, supporting the arch and de-loading the fascia can be very effective.
What can you do at home?
Stretching exercises:
Calf stretch: A pulling sensation in the tendon is normal, avoid feeling pain during stretching. repeat 5-6 times per day Hold each stretch for 30 – 60 seconds.
Knee straight: Place the leg you are stretching behind you. Keep your heel on the ground, knee straight and your toes pointed straight ahead. Lean forward until you feel a gentle stretch in your calf.
Knee bent: Place the leg you are stretching behind you. Start slightly closer to the wall. Keep your heel on the ground. Bend your back knee until you feel the stretch in the lower part of your calf.
Calf strengthening exercises:
Standing Heel Raises: Use both feet to rise onto your toes and lower the heels slowly. Assist with the unaffected side so that there is no pain in the affected side. The affected side may do most of the work at this stage. Complete 2-3 sets of 10 reps without pain.
To progress:
- Increasing the weight on the affected side and decreasing the weight on the unaffected side. The goal is 2-3 sets of 10 reps without pain.
- Do the heel raises while only using the affected leg. The goal is 2-3 sets of 10 reps without pain.
- Place your toes on the edge of a step. Use two feet at first and follow the same progression.
- Allow your heels to slowly drop below the step as you complete 2-3 sets of 10 reps.
- Do the exercise on one leg, continuing to move slowly.
If you or a family member would like to learn more about Achilles Tendinopathy and ways to improve it, the physiotherapists at Back In Motion Como would love to help!
Website: https://www.backinmotion.com.au/como
Phone Number: 9313 3414