What is Achilles tendinopathy and what causes it?
Achilles tendinopathy is a condition that causes pain, swelling and stiffness of the Achilles tendon. It is thought to be caused by repeated tiny injuries (known as microtrauma) to the Achilles tendon. After each injury, the tendon does not heal completely, as should normally happen. This means that over time, damage to the Achilles tendon builds up and Achilles tendinopathy can develop.
This is a subject close to my heart at the moment as I am experiencing symptoms.
The Achilles Tendon can be found just above the heel bone, it attaches the calf muscles, Gastrocnemius and Soleus to the heel.
There are a number of things that may lead to these repeated tiny injuries to the Achilles tendon. For example:
- Overuse of the Achilles tendon. This can be a problem for people who run regularly. (Achilles tendinopathy can also be a problem for dancers and for people who play a lot of tennis or other sports that involve jumping.)
- Training or exercising wearing inappropriate footwear.
- Having poor training or exercising techniques – for example, a poor running technique.
- Making a change to your training programme – for example, rapidly increasing the intensity of your training and how often you train.
- Training or exercising on hard or sloped surfaces.
Achilles tendinopathy used to be known as Achilles tendonitis. In general, ‘itis’ usually refers to inflammation, so tendonitis would mean inflammation of a tendon. However, Achilles tendinopathy is now thought to be a better term to use because it is thought that there is little or no inflammation that causes the problem.
How common is Achilles tendinopathy?
About 6 in 100 inactive people develop Achilles tendinopathy at some point in their lifetime. However, the chance of it developing is higher in athletes or those who train regularly or do a lot of exercise. It can be a particular problem for some runners. It used to be thought that it is more common in men than in women but this may not be true.
What are the symptoms of Achilles tendinopathy?
The main symptoms include pain and stiffness around the affected Achilles tendon. Pain and stiffness tend to develop gradually and are usually worse when you first wake up in the morning. (Severe pain that comes on suddenly and difficulty walking can be symptoms of Achilles tendon tear (rupture). See a doctor or physio urgently if you develop these symptoms.)
Some people have pain during exercise but, in general, pain is worse after exercise. Runners may notice pain at the beginning of their run, which then tends to ease and become more bearable, followed by an increase in pain when they have stopped running. Pain due to Achilles tendinopathy may actually prevent you from being able to carry out your usual everyday activities such as walking to the shops, etc. You may notice that you have pain when you touch the area around your Achilles tendon. There may also be some swelling around this area.
Do I need any investigations?
Your doctor or Physio will usually diagnose Achilles tendinopathy because of your typical symptoms and from examining your Achilles tendon. They may feel for swelling or tenderness of the tendon. They may also ask you to do some exercises to put some stress on your Achilles tendon. For example, they may ask you to stand on the affected leg and raise your heel off the ground. For most people with Achilles tendinopathy, this movement brings on (reproduces) their pain. If this does not bring on your pain, you may be asked hop on that foot. There are some other tests to make sure that there are no signs that you have torn (ruptured) your Achilles tendon.
What is the initial treatment for Achilles tendinopathy?
There are a number of treatments that may help. The treatments below are usually suggested first. They are all considered as conservative treatments. This means treatments that do not involve surgery.
Rest and time off from sporting activities are important if you have Achilles tendinopathy. At first, you should stop any high-impact activities or sports (such as running). As pain improves, you can restart exercise as your pain allows. It is thought that complete rest if it is prolonged, can actually be worse for the injury. Talk to your doctor or physiotherapist about when you should start exercising again.
Painkillers such as paracetamol or ibuprofen may help to relieve pain. Ibuprofen is from a group of medicines called non-steroidal anti-inflammatory drugs (NSAIDs). However, you should not use ibuprofen or other NSAIDs for more than 7-14 days if you have Achilles tendinopathy. This is because they may possibly reduce the ability of the tendon to heal in the long term. They may also cause symptoms of Achilles tendinopathy to be masked, or covered up, which again may delay healing.
check with your doctor or pharmacist before taking them if you are unsure if they are suitable for you.
Ice treatment may be useful for pain control and may help to reduce swelling in the early stages of Achilles tendinopathy. An ice pack should be applied for 10-30 minutes. Less than 10 minutes has little effect. More than 30 minutes may damage the skin. Make an ice pack by wrapping ice cubes in a plastic bag or towel. (Do not put ice directly next to skin, as it may cause ice burn.) A bag of frozen peas is an alternative. Gently press the ice pack on to the injured part. The cold from the ice is thought to reduce blood flow to the damaged tendon. This may reduce pain. Do not leave ice on while asleep.
Physiotherapy and Achilles tendon exercises
Some special exercises to help to stretch and strengthen your Achilles tendon have been proven to be helpful. You should aim to do these every day. Such eccentric, loading exercises may help with pain control and stiffness. A physiotherapist will be able to help you with these exercises as needed. Hands-on Physio and Acupuncture can also help to release tight calf muscles.
A Physio assessment to decide which of the calf muscles are tight or weak can help design a stretching and strengthening programme of exercises. It may be that weakness in other areas, such as the hips, are causing the Achilles to over-strain.
Call us to book an appointment for confirmation of diagnosis and for an individual treatment plan.
A physio or Podiatrist may suggest changing your footwear or putting special inserts in your shoes, such as inserts to lift your heel. This may help to reduce pain and symptoms. Supportive shoes, such as Asics Trainers will ease the effort and load of the tendon.
A note about steroid injections
Injection of a steroid medicine is a common treatment for some tendon injuries. However, the use of steroid injections for the treatment of Achilles tendinopathy is controversial and it is not approved in the UK. If steroids are injected directly into the Achilles tendon, there is a risk of damaging the tendon further. There have been cases where they have caused the tendon to tear (rupture). Another option is to inject the steroid around the Achilles tendon. But again, this is not approved in the UK. However, it is thought that this may have less effect on the tendon itself and be less likely to cause damage.