Achilles tendinopathy is one of the most common running injuries. Tendons are designed to take load. When this load changes (increases or decreases), the achilles tendon can become symptomatic.
Common causes of achilles tendinopathy
- over training (ie too much speed work, too many hills, high mileage without building up to it).
- incorrect footwear,
- flat feet (excessive pronation),
- previous ankle injuries and/or poor ankle movement,
- tight calf muscles.
Typically, tendons tend to warm up with exercise. In the early stages of an achilles tendinopathy, it is common that your achilles niggles initially in the run, but eases as the run progresses. As the tendinopathy progresses, the achilles tendon pain will actually stop you from running due to pain.
Tendons also have a delayed response, so it is common to feel pain up to 72 hours after an aggravating activity, which can make it difficult to manage.
With an achilles tendinopathy, you may find that your 1st few steps as you get out of bed in the morning are a little strained and difficult to get your heel flat on the floor.
The achilles tendon can be tender to touch.
Initial treatment needs to include load management once you have figured out the aggravating activity. It is important not to stop all activity. The achilles tendon likes to be loaded – it just needs to be loaded optimally. A general rule of thumb is that if for example your achilles hurts after a 10 km run, you need to reduce your next run to 5km and check your response. If you have no pain, you can gradually build up again. When you are building up again, it is important to not add more than one variable in your progression (i.e work on speed or distance – not both). Speak to your physiotherapist about this.
A heel raise worn in your shoes may be helpful for a few weeks. This helps to keep the tendon in a more neutral position, taking the load off the tendon and therefore reducing pain.
An assessment of your feet and footwear may be appropriate. (avoid wearing flip flops)
Avoid stretching your calf muscle as this increases the tension on the achilles tendon. Your physio will show you ways to lengthen your calf muscle without stretching it.
Strapping may be used as an adjunct to your physiotherapy treatment.
Physio assessment is important so that any underlying biomechanical problems can be addressed.
Physiotherapy will assist you with manual therapy and a rehabilitation programme. The most important part of an achilles tendon rehabilitation programme is eccentric muscle loading which involves strengthening and lengthening of the calf muscle to gradually improve the achilles tendon tolerance to load.
Tendons have a poor blood supply and typically it takes between 3-6 months to recover from an achilles tendinopathy.
Cortisone injections are not recommended as this can reduce the strength of the achilles tendon, making it more likely to snap.
There has been limited research with decent outcome measures to say that PRP (plasma rich protein) injections or shock wave are beneficial in treating this condition.