Achilles Tendinopathy

What is Achilles Tendonopathy?

The muscle group at the back of the lower leg is commonly called the calf muscle (otherwise knows as triceps surae). The calf muscle group comprises of two major muscles, one of which originates from above the knee joint (gastrocnemius), the other of which originates from below the knee joint (soleus). Both of these muscles extend down the posterior aspect of the leg and merge to form the Achilles tendon. The Achilles tendon is a very thick, long and powerful tendon that extends down and inserts directly onto the posterior aspect of the calcaneus (heel bone).

Current research reveals that during constant period of excessive loading, such as running and cycling every day, a tendon will pass through the following phases:

Normal tenon--> Reactive Tendonopathy-->Tendon Dysrepair (failed healing)--> Degenerative Tendonopathy-->Tendon Rupture

Reactive Tendonopathy

This is a non-inflammatory response which is a short-term adaptive phase. This takes place in the short-term to allow the tendon to cope with loads through thickening and stiffening. The tendon can revert back to normal structure if overload is reduced or sufficient time is given between loading.

Tendon Disrepair

During this phase of tendonopathy, there is collagen fibre breakdown and inflammatory markers (hormones) within the tendon itself. It is at this stage, that treatment and load reduction becomes critical before it reaches the degeneration phase.

Degenerative Tendonopathy

This is known as the “the point of no return”. The damage to the tendon in this stage has become such that it will no longer be able to repair itself.

Typically, tendon injuries with the Achilles tendon occur in two areas; the mid portion or insertion into the calcaneal bone (heel bone).

Tendonopathy will occur when the load placed through the tendon is greater than the rate at which it is able to repair itself. Achilles Tendonopathy is a classic case of “doing too much too soon”.

Signs and Symptoms

Symptoms of Achilles Tendonopathy can include:

  • A dull ache post exercise at the back of the heel

  • Mild swelling located within the Achilles tendon

  • Pain immediately after a period of rest (ie. hopping out of bed in the morning)

  • Pain during the early phase and/or towards the end of your training session

  • In a large number of cases pain can ease after approximately 15 minutes into a session

  • Usually pain is present on resisted plantar flexion (such as pressing the pedals in your car or bike) or closed chain plantar flexion movements (such as standing on your toes or during the “propulsion phase” of your gait cycle)

  • Pain can often be present when wearing closed in shoes such as runners

  • Pain on palpation of the Achilles tendon

  • Pain on compression of your calcaneus (heel bone)

Treatment of Achilles Tendinopathy

Current research explains that the only effective long term management of tendonopathy is to perform a targeted, specific strength based treatment program in order to promote cell growth with the tendon and repair the damaged collagen fibres. If left too long, tendons can reach a “point of no return”, whereby the inflammatory cycle within the tendon is in a constant state of degeneration.

If you're going to take anything away from today's article, it is to seek treatment as soon as you develop pain within the Achilles tendon.

The most effective way of strengthening your Achilles tendon is to perform a series of calf raises done with the correct technique.

Tips to perform a calf raise correctly:

  • Stand with legs approximately shoulder width apart

  • Always practise on a flat surface

  • Ensure feet point straight

  • Keep legs straight at all times

  • Slowly raise your body weight to your toes, hold for a second and slowly lower back down to the ground

  • Focus all of your body weight through your first big toe joint

The most important thing to remember is a slow and controlled movement. Any fast movements render this exercise pointless. By performing the exercise in a slow and controlled manner, you are allowing the muscle belly to engage properly.

NB: this exercise can be progressed to being performed on a stair or single leg, but needs to be judged by your Podiatrist or Physiotherapist first.

Other treatment modalities for Achilles Tendonopathy include:

  • Proper footwear prescription

  • Heel lifts to be placed in your shoes to offload the Achilles tendon

  • Calf and Achilles stretches

  • Compression socks to be worn during and after exercise

  • Reduction or modification to your current load

  • Foam roller and massage sticks to be performed daily along the calf muscles and Achilles tendon

If you are developing pain in you Achilles region get it seen to immediately so you're able to be given an individualised, targeted treatment program in order to get you back to your best ASAP!

Ryan Twist is a Sports Podiatrist practising out of Bayswater Foot and Ankle Clinic in Melbourne's outer east. He founded the clinic 5 years ago after returning home from working at Sports Podiatry Clinic in Canberra, where he gained valuable experience working with athletes at the Australian Institute of Sport. He has a passion for triathlons having competed in 7 Ironman’s and 10 Half Ironman’s - and qualifying for the World Ironman Championships in Hawaii. Some may say he is crazy, but let's not tell him that!

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