What is Achilles Tendinopathy? The Symptoms & Treatment Options

According to the Australian Physiotherapy Association, approximately 6% of the population or 1.5 million Australians will experience Achilles tendonitis at least once in their lifetime.[1] Long-distance runners especially have a high risk of developing Achilles conditions. Approximately 30% of runners will eventually develop Achilles tendonitis.

The Achilles tendon naturally becomes inflamed in response to overuse and excessive strain. Over time, the persisting inflammation can lead to Achilles tendonitis and progressively worsen if not managed properly. Additional changes, such as swelling, pain and even permanent degeneration can occur with persistent irritation of the tendon.

What is Achilles Tendinopathy?

Achilles tendonitis is a common condition defined by inflammation of the Achilles tendon that causes pain along the back of the leg near the heel. The Achilles tendon is the connective tissue connecting the calf to the calcaneus (heel bone).Overuse of this muscle is the primary cause of pain.

According to BioMed International[2], Achilles tendinopathy is defined as “a painful overuse injury caused by excessive stress and compression of the Achilles tendon during physical activities”.

What are the symptoms of Achilles tendinopathy?

The main symptoms of Achilles tendinopathy include pain and stiffness around the back of the heel. These symptoms tend to develop over time, with most patients reporting that symptoms are worse first thing in the morning.

Common symptoms of Achilles tendinopathy

• Swelling at the back of the ankle

• Stiffness and decreased range of motion

• Morning pain

• Increase in pain after physical activity or exercise

• Tenderness around the back of the heel

What causes Achilles tendinopathy?

Achilles tendinopathy is caused by repetitive strain on the Achilles tendon, often caused by running or jumping sports like basketball. Besides sporting injuries, Achilles tendinopathy can be caused by foot issues, poor footwear or obesity.

Common causes of Achilles tendinopathy

• Running on a hard surface

• Poor training techniques such as progressing too quickly

• Inappropriate exercise footwear

• Recurrent injury to the Achilles and calf

Sports that increase the risk of Achilles tendinopathy

Running sports and high-impact activities can increase the risk of Achilles tendinopathy. Here is a list of the most common sports that can result in Achilles tendinopathy.

• Basketball

• Tennis

• Running

• Dancing

• Skiing

How is Achilles tendinopathy diagnosed?

Having Achilles tendinopathy can limit your mobility and lessen your participation in sports activities. Additionally, it can lead to complete rupture of your Achilles if left untreated.

There are several options available when it comes to diagnosing your knee pain as Achilles tendinopathy. One of the more common and most recommended by Australian GPs is an assessment from a physiotherapist.

Physiotherapists are sports rehabilitation experts that deal with tendon injuries such as Achilles tendinopathy. They are medically qualified to diagnose and give you the best treatment.

Your evaluation with a physiotherapist is comprehensive and straightforward. Your physiotherapist will ask you related questions regarding your injury and lifestyle. Take this time to discuss all your symptoms and associated medical conditions.

After establishing a background for your injury, your physiotherapist will perform a physical assessment of your ankle and Achilles tendon. Your physiotherapist may compress the areas of your leg and have you do a series of movements to rule out other factors that may be causing your pain.

Your physiotherapist will then create a specific treatment plan for you and will guide you through your recovery.

This will also include:

• Complete recovery program

• Estimated time of your recovery

• Home exercises

• Sports guidance and risk prevention strategies.

How is Achilles tendinopathy treated?

Achilles tendinopathy can be frustrating, especially right after you wake up in the morning. In addition, stiffness and pain can prevent you from partaking in your usual daily routine.

There are several options when it comes to treating Achilles tendinopathy. One of the more common and the treatment option referred to by Australian GPs the most is physiotherapy.

Physiotherapists routinely encounter sports injuries like Achilles tendinopathy. They are the mainstay and go-to medical professionals when it comes to tendon injuries.

The primary goal of your treatment is to decrease the inflammation. This helps to ensure the rate of soft tissue healing is better than the rate of degeneration. Your physiotherapist will also focus on reducing your risk of re-injury to help you get back to sports as quickly as possible.

Depending on the severity of your Achilles tendinopathy, a physio may provide you with a combination of the following types of treatments:

• Cryotherapy - Use of cold modalities to reduce swelling and pain in the short term.

• Dry needling - Specialised acupuncture techniques to help reduce the pain.

• Manual Therapy - Hands-on techniques used by your physio to improve pain and joint mobility.

• Taping - Specialised taping techniques provide additional stability for the foot and decrease strain on the Achilles tendon.

• Stretching Exercises - Gentle stretching to help relieve muscle tension and prevent stiffness.

• Therapeutic Exercises - Exercise techniques to correct impairments that may be contributing to your injury.

• Sports-specific Exercises - Specialised exercises to help you regain your function and prevent re-injury towards the end of your rehab.

A typical physiotherapy session with your local physiotherapist will last anywhere between 30-60 minutes. It is not uncommon for patients to feel the benefits in just one session.

Next step - Creating a treatment plan made for you

After the assessment, your physiotherapist will create a detailed treatment program that is tailored to your rehabilitation goals.

Self-care for Achilles tendinopathy

If you think you have Achilles tendinopathy, here are the best things you can do and avoid.

Things to do:

• Rest

Tendon injuries happen due to excessive stress and overloading during physical activities. Give your body enough time to heal by resting and drinking enough water throughout the day.

• Ice

Apply ice to the sore areas of your Achilles to decrease pain and manage the inflammation.

• Massage

Apply gentle pressure on the calf and Achilles tendon to relax the muscles and relieve some tension.

• Stretch

Gently stretch the muscles and tendon of your foot and calves to relieve tension and maintain your normal range of motion.

• Exercise

Remember that complete rest is not advisable if your condition is chronic. You still have to remain active and do controlled strengthening exercises to strengthen the tendon and help it recover.

Things to avoid:

• Avoid wearing high-heeled shoes

High-heeled shoes put your Achilles tendon in a contracted position which increases the stress and prevents it from resting while you are wearing it.

• Avoid pushing through the pain.

Achilles tendinopathy may present as dull pain at the start or during your activity. Pain is your body’s signal that something needs your attention. Pushing through the pain can cause avoidable damage to the Achilles tendon.

Do I need a specialist or surgery?

Your GP may order diagnostic imaging to confirm their diagnosis and rule out other factors causing your symptoms.

• Ultrasound: Used to assess the integrity of the Achilles tendon.

• X-ray: Used to check for the presence of arthritic changes, bone formation or scan deformities that contribute to your pain.

• MRI: Used to show the degree of damage or degeneration around the Achilles tendon.

Your GP may prescribe you corticosteroid injections for short-term pain-relieving effects.

Surgery may also be done to remove parts of the tendon and stimulate soft tissue healing action of the body in response to trauma. This is a very rare situation, and will only be performed if conservative treatment has not been effective.

Your GP will coordinate with your physiotherapist to maximise your recovery and to provide you with the best possible treatment options.

What is the recovery time / prognosis for Achilles tendinopathy?

Ultimately, recovery time is dependent on being proactive and seeking professional treatment along with the severity of your foot pain and injury.

Because of the limited blood supply in the Achilles tendon, injuries to the area can take a while to heal. Full recovery from Achilles tendinopathy may take several months to heal. Although pain and stiffness gradually get better in a few weeks, the Achilles tendon requires proper rehabilitation to ensure the best outcomes.

Through physiotherapy, you can accelerate your healing time. It also ensures your optimal recovery and helps improve your odds of returning to sports.

Important factors in recovery include:

• Sticking to your rehabilitation program and regularly exercising

• Resuming your sports activity gradually

• Paying attention to pain, and resting as necessary.

Can Achilles tendinopathy be prevented?

Guaranteeing prevention can be impossible; however, you can decrease the risk of Achilles tendinopathy through some of these techniques:

• Stretch regularly - Stretch your foot and calf muscles to relieve tension on the Achilles and help maintain your natural range of motion.

• Increase your activity level gradually - Start slowly and progressively increase the level of your physical activity to give time for your tendon to adjust to the number of demands you are putting on it.

• Choose appropriate footwear - Proper footwear can help you prevent injuries. Choose footwear with adequate cushioning for your heel and make sure it has firm arch support.

• Strengthen your calf muscles - A strong calf muscle enables the Achilles tendon to be resilient in handling the stresses of high impact activities.

• Pace your activities - Avoid excessive stress on the Achilles tendon and allow proper recovery periods.

Outlook and the main takeaways

Achilles tendinopathy can take a long time to heal, but full recovery can be achieved through lifestyle modification, appropriate treatment and effective rehabilitation.

Book a session with a physiotherapist today to prevent complications of Achilles tendinopathy and start your recovery immediately.

Anatomy of the Achilles tendon

The Achilles tendon is a thick connective tissue that connects the calf muscle to the heel bone. It is located at the back of the leg, and it is the strongest tendon in the human body.

When the calf muscle contracts, the Achilles tendon pulls the heel bone, creating a strong push-off in walking. This allows you to do vital movements such as walking, running and stair ambulation.

Chronic and repetitive stress on the Achilles tendon may result in degeneration of the tendon. Since the Achilles has poor blood circulation, the soft tissue healing rate may not be enough to overcome the degeneration rate of the Achilles tendon.