Achilles Tendonitis

Achilles tendonitis is one of the most common conditions our podiatrists encounter in our clinics, with the condition occurring in all patient demographics, although it is commonly seen in athletes, particularly those athletes returning to exercise after a long period sedentary.

The condition is typified by pain in the mid part of the tendon and /or at the insertion point on the back of the heel bone. This condition has multiple causes and a thorough history and assessment is necessary.

What causes Achilles Tendonitis?

The condition is typified by pain in the mid part of the tendon and /or at the insertion point on the back of the heel bone. This condition has multiple causes and a thorough history and assessment is necessary. During contraction of the calf, tension is placed through the Achilles tendon. When this tension is excessive, due to too much repetition or high force, damage to the tendon can occur. This damage to the tendon subsequently causes degeneration and inflammation. This may occur traumatically, due to a high force going through the tendon beyond what it can withstand, or due to gradual wear and tear associated with overuse.

There are two classifications of injuries that fall under tendinopathy:

  • Tendinitis-an inflammation of the tendon. (This term has previously been used to describe any injury to the tendon and although this term is used often, most cases of tendinopathy are not associated with significant inflammation.)
  • Tendinosis-microtears (tiny breaks) in the tendon tissue with no significant inflammation.

What does the pain feel like?

This condition may present as pain and swelling at the insertion of the Achilles tendon into the calcaneus (heel bone) or at the mid-portion of the tendon, approx. 5cm from insertion into the calcaneus (heel bone). It can also lead to limited motion throughout the ankle.

What causes Achilles Tendonitis?

Achilles Tendon DegenerationAchilles tendonitis is most commonly brought about through physical activity or a sudden change in activity such as increasing the distance of a daily run. This condition causes degeneration of the tissue and means that the Achilles tendon does not possess its normal tensile strength and may be liable to rupture with continued sporting activity.

How we Achilles Tendonitis at Balance Podiatry.

Apart from treatment to reduce pain and inflammation, it is pertinent that a thorough biomechanical assessment is performed using video gait assessment software. Subtleties such as timing of heel-off in the gait cycle can cause injury to the tiny collagen fibres that make up the tendon. These subtleties are difficult to see at normal speed with the naked eye, but can be seen easily using computerised video gait assessment. Treatment often involves a combination of pain relief medication, stretching, strengthening, rest and changes to footwear and or foot function using custom-made orthotics.

Treatment may include:

  • Appropriate stretches
  • Strengthening exercises
  • Strapping
  • Footwear advice/modifications
  • Orthotic therapy
  • Exercise and training program modifications