Understanding Achilles Tendinopathy in Singapore’s Active Population
Tendons are thick, fibrous cords of connective tissue that connect muscles and bones to facilitate movement. The Achilles tendon, the strongest tendon in the body, is responsible for flexion of the knee and plantarflexion of the ankle joint for actions such as running, climbing, and jumping. Repetitive stress to this tendon can cause it to become inflamed and irritated, resulting in Achilles tendonitis. This type of inflammation of the tendon often involves tensile overload, especially at the mid-portion where strain on the tendon is typically greatest during propulsion and toe-off.
Achilles tendinopathy can occur if inflammation and microtrauma to the Achilles tendon does not heal properly, causing further damage to build up over time. The ensuing collagen degeneration and scar tissue formation reduces tendon flexibility, causing it to thicken, along with forming lumps within the region of scar tissue. Calcifications can develop at the insertion point of the Achilles into the calcaneus, and even extend into the tendon in chronic cases of Achilles tendinopathy. Further overuse or increase in intensity of physical activity without proper biomechanical alignment can cause the tendon to 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
- Mild to severe aching pain the day after exercising
- Pain and stiffness along the tendon in the morning
- Swelling at the injury site
- Noticeable lump development at the posterior heel
Other contributing factors include obesity, age, and diabetes, which are known risk factors for musculoskeletal disorders like Achilles tendonitis. Individuals who participate in sports, such as basketball, running, and gymnastics, face a higher risk of Achilles tendon injuries due to high training load and repetitive strain. The tendon can experience stress loads of up to four times the body weight during walking and up to eight times when running.1
Continuous pressure on the lower limb must be reduced if signs of Achilles tendonitis or tendonopathy are present. Early intervention is vital, and it is important to fully assess the condition with the guidance of a podiatrist, especially to differentiate it from conditions such as patellar tendinopathy, iliotibial band irritation, or hip osteoarthritis. These overlapping pain presentations can reflect broader pain syndromes, including patellofemoral pain or impingement.
To prevent further damage to the tendon, please consult a podiatrist for advice or a second opinion from an orthopaedic or foot and ankle surgery team if your symptoms worsen or become recurrent.
How Do I Prevent Achilles Tendonitis?
- Choose appropriate footwear for specific activities to support the plantar surface and heel alignment
- Perform warm-up and cool-down exercises to reduce strain on the tendon during physical activity
- Maintain flexibility and a healthy range of motion with regular stretching
- Monitor and adjust your exercise prescription and avoid increasing training load too rapidly
- Be mindful of terrain changes and surface conditions to minimise biomechanical disruption
If your condition is recurrent or deteriorating, conservative care like physical therapy should be initiated early. With professional advice, non-surgical care can be tailored to reduce the risk of further degeneration and tendon tear, while improving propulsion and overall performance.