Tendons are thick, fibrous cords of connective tissue which connect muscles to bone. They facilitate movement of a bone or structure. In this case, the Achilles tendon is responsible for helping the knee joint to flex and plantarflexion of the ankle joint. Under too much strain and stress, even the strongest tendon can become injured. Overuse can cause the tendon to become inflamed, this is known as Achilles Tendonitis or Tendonitis. As the injury progresses, collagen degeneration and scar tissue formation can occur within the tendon. This deterioration of the Achilles tendon is known as Achilles Tendinopathy. Not only does this reduce the flexibility of the tendon, thickening or lumps can be felt within the region of scar tissue. If further overuse injury occurs, the tendon could rupture or tear.
Symptoms of Achilles Tendonitis
- Ache or sharp pain anywhere along the back of the tendon and posterior heel
- Limited ankle flexibility
- Redness or heat over the painful area
- Severe pain the day after exercising
- Pain and stiffness along the tendon in the morning
- Swelling at the injury site
Causes of Achilles Tendonitis
Achilles tendonitis is typically not related to a specific traumatic incident, and results from repetitive stress of the tendon. This can be seen when individuals push their bodies too much and/or too soon, but other factors can also contribute to the injury. These factors are:
- Leg length discrepancy
- Increasing the intensity of activity too quickly
- Changing training surfaces too abruptly (soft to hard)
- Inappropriate footwear
- Too tight or fatigued muscles
- Not stretching enough before activity
- Deviated or unstable rearfoot axis
Other factors such as obesity, age, and diabetes can also predispose an individual to sustaining an Achilles tendon injury. From a physiological perspective, the lowered blood circulation around the Achilles tendon predisposes it to delayed healing compared to other tendons in the body. The Achilles tendon can receive a stress load of up to 4 times our body weight while walking… now imagine the stress load when running and jumping! That is why Achilles tendon injuries are most common in high-load, high-impact sports such as Basketball, Running, and Gymnastics. Due to the frequent use of this tendon, Achilles tendon pain should be treated as soon as possible to prevent it from deteriorating.
Achilles Tendonitis Treatment
- R.I.C.E (Rest, Ice, Compression, Elevation) for a new injury – Rest the injury by cutting back on daily activities. Ice the injury using an ice pack for 15 mins several times a day. Ice calms down the damaged tissue and slows down blood flow to an injury, reducing swelling, inflammation and controlling the pain. Compression can be performed using an elastic wrap or bandage. Lastly, Elevate the affected limb to reduce the swelling.
- Eccentric stretching of the calf muscles daily, after the acute pain and inflammation has abated.
- Strengthening of the leg muscles and ankle stabilizers.
- Ultrasound and/or Shockwave Therapy can accelerate the body’s healing process, produce pain relief, promote reduction in muscle tension, and stimulate neovascularization.
- Customised foot orthotics will improve foot alignment and control joint motions during propulsion/ toe-off in the gait cycle.
- Immobilization is needed if the injury is severe.
Prevention of this injury includes wearing correct footwear for specific activities and lifestyle. Individuals participating in sports or exercise should warm up properly before, and stretch and cool down after, as well as alternate training regimes where possible. Stretching is very important to injury prevention by maintaining optimal range of motion and increasing flexibility. Changing exercise routines slightly can make a big difference in avoiding an overuse injury such as Achilles tendonitis.
If your condition is recurrent and deteriorating, then you need to be mindful of preventing an eventual tendon tear or rupture. Podiatrists are lower limb specialists who will assess and diagnose your issue, then devise a treatment plan which will accelerate your recovery, optimise your sports performance, and most importantly, treat the pain in your Achilles tendon.
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Content By: East Coast Podiatry Edited By: Dr Michael Lai, D.P.M.
Last Updated: 16 May 2019