ACHILLES TENDINOPATHY

Achilles tendinitis is a common condition that occurs when the large tendon that runs down the back of the lower leg becomes irritated and inflamed.  The Achilles tendon is the largest tendon in the body and attaches to the lower portion of the Gastrocnemius and Soleus muscles (aka calf muscles to the back of the heel). The Achilles tendon is essential for everyday activities such as walking, running and jumping, and is subject to high loads of repetitive stresses. Achilles tendinopathy is an overuse injury of the Achilles tendon. 

Achilles tendinitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too quickly. Other factors can also make a person more likely to develop Achilles tendinitis, including:

• A sudden increase in the amount or intensity of exercise activity. For example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance may cause irritation and inflammation.
• Tight calf muscles. Calf muscle tightness puts extra stress on the Achilles tendon, especially where it inserts into the heel bone.
• Haglund's deformity. This is a condition in which there is enlargement of the bone on the back of the heel. This can rub on the Achilles tendon and cause inflammation and pain. 

An Achilles tendinopathy injury can be acute or chronic and the tendon can degenerate with chronic cases. Acute is a sudden flare up whereas chronic is 6 months duration. Achilles tendinopathy can occur at 2 locations:

• The insertion of the Achilles tendon at the attachment to the heel bone, known as insertional tendinopathy
• Mid-way through the tendon, known as ‘mid-portion tendinopathy

Common Symptoms:

• Pain and stiffness along the Achilles tendon in the morning
• Pain along the tendon or back of the heel that worsens with activity
• Severe pain the day after exercising
• Thickening of the tendon
• Swelling that is present all the time and gets worse throughout the day or with activity

Diagnosis is often through a clinical assessment and biomechanical examination completed by a podiatrist.  Based off this assessment you may/may not be referred for an ultrasound to determine the extent of degeneration and to assess if there are any tears in the tendon.

• Ice and relative rest
• Strengthening exercises
• Heel raises
• Supportive taping
• Footwear advice
• Custom orthotics
• Load/Exercise modification
• Dry needling
• Compression sleeves
• Shockwave therapy (Ultrasound clearance required)
• Surgery (in chronic cases)