Achilles Tendinopathy

Tendinopathy is a term which is often used to describe overuse injuries of a tendon. Hence an Achilles Tendinopathy describes an overuse injury of the Achilles region. There are two types of Achilles Tendinopathy: midportion and insertional, and these can often present in different stages.

Anatomy:

The Achilles tendon is located where the calf muscles (Gastrocnemius and Soleus) insert into the back of the heel (calcaneus) in one common tendon. These muscles are responsible for the action of plantar flexion of the heel (pointing the foot or coming up onto toes). They are important for propulsion in walking and running.

Clinical Presentation:

Usually insidious onset.

  • Pain is localised to the Achilles tendon and immediate surrounding area.
  • Morning pain when getting out of bed and walking.
  • Swelling may be present.
  • Changes in the tendon outline, becoming thicker.
  • Pain with calf raised, running or walking.
  • Pain when the tendon is loaded or put on stretch.

Causes:

There can be many causes for tendinopathies. The most common internal factors include abnormal foot mechanics, calf weakness, calf muscle tightness or stiff ankle joints. Common external factors include sudden increases in training load e.g. increase in running, poor footwear, changes in running surfaces e.g. grass to concrete and hills, or decreased recovery time between training sessions. These factors combine to cause repeated micro trauma to the musculotendinous unit, which, when not treated properly, does not allow the tendon to regenerate or heal appropriately.

Management:

Conservative treatment can often lead to significant improvements in the patient’s pain, and Physiotherapy is often indicated. Subsequently, management should include appropriate level of activity, equipment changes (footwear or inserts), strength and flexibility training. Advice and education about tendinopathies, anatomy, activity and load modification should be provided. An exercise program should include eccentric loading of the tendon and incorporate a stretching program targeting both Gastrocnemius and Soleus muscles. Physiotherapy manual therapy techniques may also be applied such as deep transverse frictions, ice massage and ankle mobilisations. Physiotherapy electrotherapy modalities, taping and dry needling may also be applied.

Once symptoms have subsided, a supervised and progressive exercise program can be provided by a Physiotherapist and an Exercise Physiologist for specific return to sport, or activity goals. This ensures flare ups can be managed if they present during rehabilitation, and that further tendinopathies do not recur.

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