What is Achilles Tendinopathy?
The Achilles tendon connects the calf (the back of the lower part of your leg) muscles to the heel bone and helps you to push up on your tiptoes. Achilles tendinopathy is an injury to this tendon, most often due to an overload. The tendon is unable to cope with the strain being applied to it.
It is not necessary to carry out x-rays or scans to diagnose Achilles tendinopathy, it is usually confirmed by taking a medical history of the patient and completing a physical examination.
Why do I have it?
Approximately 6% of people will be affected during their lifetime, and one in three of these people will get it on both feet. It is a common injury affecting runners due to increased loads the tendon is under, having to overcome 4-6 times the force of body weight. Those who are overweight, stand for excessive periods (at work for example), runners and people over age 40, are more likely to have plantar heel pain.
What are the symptoms of Achilles tendinopathy?
The typical symptoms include pain, stiffness and some swelling of the back of the heel and ankle.
Pain is often present first thing in the morning or when you begin to walk after resting for a period of time. The pain can be variable and it can improve as you keep moving. You may notice it can be painful after lots of weight-bearing activities such as walking or running.
In some cases, the area may become red, warm and tender to touch, swollen or thickened in appearance.
What causes Achilles tendinopathy?
The causes of Achilles tendinopathy are not fully understood, but there are many factors that can contribute to it, including:
- Being overweight.
- Tight or weak calf muscles.
- Stiff ankle joints.
- Sudden large increases in activity levels, for example, running, walking, playing sports.
- Training errors, including a lack of variety in training, or too much hill running.
How is Achilles tendinopathy managed?
To reduce pain in the short term you can try the following:
- Relative rest: reduce activities on your feet such as prolonged walking or running but you can maintain your fitness by doing other forms of exercise, such as cycling or swimming.
- Pain relief: painkillers may be used to provide short term pain relief.
- Ice: applying ice, wrapped in a towel, can help with pain and swelling in the early stages.
- Footwear: Choosing supportive footwear and no flat shoes can help in relieving pain.
As Achilles tendinopathy is related to the ability of the tendon to cope with load, exercises specific to strengthening this tendon will help healing and return to activity. Exercises specific to the tendon are needed to help recovery, but overloading the tendon may worsen the pain.
Your podiatrist may identify other specific exercises for you to complete and may refer you to a physiotherapist to monitor your performance and progression of these carefully.
How long does it take to get better?
Everybody will improve differently. If the symptoms are addressed early, then a return to activity can be within a matter of weeks. For most people it will take six to nine months of focused rehabilitation to make a return to full activities without pain. It is normal to have some periods of increased pain or flare ups during your recovery.
If your symptoms don’t improve within six to nine months, even when you have been completing an appropriate exercise programme, other treatment options, such as shockwave therapy may be considered and can be discussed with a medical professional if appropriate.
Is there anything I can do to help myself?
If you happen to be overweight, losing weight will help, as it will reduce the amount of load going through the tendon as you walk and exercise. If you think you need more help with weight loss, please discuss this with your podiatrist or GP.
Exercise and physical activity
While the heel area is painful, you should temporarily reduce weight-bearing activities such as running and strenuous walking. It is, however, important that you remain physically active. It is important that as the pain improves, you gradually increase running or walking to prevent the pain recurring.