Achilles Tendinopathy
Achilles Tendinopathy is a common overuse injury caused by repetitive and excessive compression of the Achilles Tendon (1). Achilles Tendinopathy can be Insertional or Mid-portion, the difference being the location of the injured tissue. Insertional Achilles Tendonopathy is situated where the Achilles attaches to the Calcaneus, whilst the Mid-portion variation is located at the level of the tendon body in the middle of the tendon (1).
Classic Subjective History Findings include:
Insertional: pain at insertion of Achilles onto posterior calcaneus
Mid-Portion: pain in middle of tendon, felt when plantar flexing the ankle. More coming in joggers and athletes.
Patient may have had a sudden increase in running mileage
Stiffness and pain when first walking in the morning, and after prolonged sitting
Very painful with first few steps walking. Warming up makes it feel better.
Worse with increased load.
Classic Objective findings may include:
Pain with palpation over either the insertion or the mid-portion of the Achilles.
Swelling or thickness over the Achilles area.
Strength and flexibility are often limited on the side of the tendinopathy.
Management
Short-term and Symptomatic Management
Manual therapy such as soft tissue massage to loosen any tight structures (1).
Decrease load through Achilles (eg. reduce running load, softer surfaces) (1) but not total rest.
Isometric exercises are key - foot half off step, 1 minute on 1 minute, 5 reps (2).
Long-term Results
Progression of exercises including isotonic exercises for strength, endurance and plyometrics (2). Progressions should be made with careful consideration by a physiotherapist taking into account tissue adaptation and patient goals.
Correction of any biomechanical abnormalities present.
Shockwave therapy has been shown to help reduce pain and facilitate the repair process (2).
References
1. Murphy, M., Travers, M., Gibson, W., Chivers, P., Debenham, J., Docking, S., & Rio, E. (2018). Rate of Improvement of Pain and Function in Mid-Portion Achilles Tendinopathy with Loading Protocols: A Systematic Review and Longitudinal Meta-Analysis. Sports Medicine, 1-17.
2. Al-Abbad, H., & Simon, J. V. (2013). The effectiveness of extracorporeal shock wave therapy on chronic achilles tendinopathy: a systematic review. Foot & ankle international, 34(1), 33-41.
3. Retrieved from: http://www.nstt.com.au/achilles-tendinopathy/