The Achilles tendon, the largest and strongest tendon in the body, connects the calf muscles (soleus and gastrocnemius) to the heel. The Achilles lifts us up on our toes, raising the heel, and plays a critical role in walking, running and jumping.
Pain near the heel or along the back of the leg, tenderness on palpation of the tendon and surrounding tissues indicate an issue with the Achilles tendon. Achilles tendinopathy more often affects athletes, for example runners, dancers, and volleyball players, but also affects sedentary adults.
Tendinopathy can result from
· Over-use such as repetitive mechanical loads or overload in training
· Acute and then chronic phases of inflammatory ‘‘tendinitis’’ that lead to tendon degeneration.
Chronic inflammation was once thought to be the cause of pain. However , no inflammatory cells are found in the area once the issue becomes a chronic problem. When there is an increase in training load a tendon may not be able to adapt fast enough for the changes. Exceeding the strength of the tendon leads to small tears. Typically a tendon will heal and remodel. However, if the increased training continues, progressive tendon changes occur which then become symptomatic.
Additional symptoms of tendinopathy include morning stiffness and thickening of the Achilles tendon, decreased function (difficulty walking), limited range of motion (particularly dorsiflexion) and localized swelling.
Diagnostic imaging is not necessary to diagnose Achilles tendinopathy, Ultrasound (US) and MRI can verify a clinical diagnosis. US may indicate the tendon thickening, discontinuity of fibers and changes in water content.
Age, genetics, limitations or excess in ankle joint and/or foot movement, gait disturbances (lateral heel strike with compensatory pronation), ankle instability and other biomechanical factors play a role in the development of tendinopathy. Muscle weakness/imbalance, increases in physical load, repetitive loading, excessive force, training errors, poor training, shoes and running surface can contribute as well.
Treatments for Achilles tendinopathy include, ice, rest, anti-inflammatory agents, corticosteroids, manual therapy, exercise (stretching, eccentric loading), ultrasound, taping, orthotics, heel raise inserts, needling (acupuncture, intramuscular stimulation), low level laser therapy, and extracorporeal shockwave therapy. Physical therapy management starts with identifying the significant contributing factors and may include any of the listed treatments. Eccentric exercises have been show to improve tendon structure and increase collagen production with both short and long term effects.
For further information, please call or email us to speak to one of our physiotherapists.
U. Fredberg1, K. Stengaard-Pedersen. Chronic tendinopathy tissue pathology, pain mechanisms, and etiology with a special focus on inflammation. Scand J Med Sci Sports 2008: 18: 3–15
J L Cook,1 C R Purdam. Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. Br J Sports Med 2009;43:409–416.