Achilles Tendonopathy

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 What is Achilles Tendonopathy?

Achilles tendonitis is characterised by pain in the thick tendon at the back of the ankle joint. the term tendonitis has fallen out of favour as studies have found a lack of inflammation in all but the very acute cases making the -itis redundant. It is now more commonly called a tendonopathy referring to pathology of the achilles tendon rather than specifically inflammation.

What causes Achilles Tendonopathy?

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Overuse syndrome to the mid portion of the achilles tendon

It is essentially an overuse syndrome very common in runner’s and sports involving jumping, but it is not limited to sports people. Risk factors involve poor technique, weak muscles, poor flexibility, poor foot biomechanics, excessive training and overuse. Micro tears form in the tendon and your body attempts to repair this. Neovascularisation occurs which means new blood vessels grow into the tendon in an attempt to repair the tissue. With blood vessels comes nerve supply which when irritated by the action of the tendon causes a painful stimulus to be sent to the brain. In severe cases cysts can form in the tendon and it can even lead to full rupture.

What are the symptoms?

The symptoms or Achilles Tendonitis are very local to the tendon and generally strike in the midportion (just behind the ankle joint). In some cases it can occur at the insertion onto the heel bone itself. It is characterised by pain and stiffness in the tendon during heavy use, after rest or both. It tends to be quite painful first thing in the morning. Some people have pain at the start of exercise which subsides during the activity only to return afterwards.

Simple advice

Rest from the aggravating activity is imperative. Also, a heel raise inside your shoe can offload the tendon preventing irritation, especially if the site of pain is at the attachment to the heel bone.

Treatment

Specific exercises and stretching

The treatment with the highest from of evidence base is strengthening exercises but it is essential that these are performed correctly and have been prescribed by a physiotherapist and adjustments made to suit your particular presentation.

Kinesiology taping

To offload tension and ease pain from the painful tendon

Soft tissue massage

To release tight muscles that will place longitudinal tension on the tendon

Ultrasound therapy

Sound wave therapy to optimise the inflammatory process (Acute tendonitis only).

Acupuncture

For pain relief and to stimulate the healing process.

Biomechanical correction and orthotic provision

If the way you hips, knees and ankles are aligned is poor this can alter the pull on the tendon causing it to become painful. Correction of this with exercises and sometimes orthotic provision may be necessary.

Your tissue heals at a rate that cannot be accelerated, only optimised, so expect resolution for chronic cases to take at least 3 months with treatment.

Failure to take action can lead to many years of discomfort.

More recalcitrant cases may require attention from an Orthopaedic surgeon but surgery is rare and best avoided if possible.