Achilles Tendinopathy

Achilles tendinopathy is a painful and often disabling condition associated with pain around the Achilles tendon. More often than not patients complain of pain around the tendon itself, usually localised to one point. However pain can also present at the insertion of the tendon into the heel bone, the calcaneum, which is otherwise known as insertional achilles tendinopathy, or behind the tendon in the bursa, which is otherwise known as retro calcaneal bursitis.

Presentation is usually reported as a gradual onset of pain; this is due to tendon degeneration and its inability to cope with load from the lower limb. As the tendon tissue begins to degenerate minute tears with the tendon body develop. These changes in the health and vascularity of the tendon then become pain generating.

Conversely patients who have suffered a rupture of the achilles will have unknowingly experienced the same degeneration of tendon health, although not painfully. These changes in tendon health and minute tears weaken the tendon ultimately causing its rupture. Typically this group of patients does not usually report achilles pain prior to a rupture.

Achilles tendinopathy is typically due to an overuse condition often associated with prolonged episodes of exercise such as running or walking, although it is not exclusive to this group.

Signs and symptoms

  • Mild ache in the tendon and tenderness around the tendon itself
  • Pain and stiffness in the tendon on rising in the morning, however these symptoms diminish with walking around or after applying heat, such as a hot shower
  • Pain during exercise training which diminishes but then returns several hours afterwards
  • Thickening around the tendon body, although often mistaken for swelling
  • Episodes of more intense pain with activities such as ascending the stairs, brisk walking, sprinting or  running; high demand activities that require lengthening or a stretch to the tendon.

How physiotherapy can help

Tendon healing usually occurs over a 12 week period, however dependent on the severity and chronicity of the problem, your physiotherapist will be able to determine your length of recovery, following a comprehensive assessment.

For acute, newly diagnosed tendon problems of six weeks or less, rest and moderation of activities is paramount to allow tendon healing. Your physiotherapist will discuss this with you.

For more chronic tendon pain sustained prior to the six week period, physiotherapy can help promote tissue healing, reduce pain and begin to strengthen surrounding muscles, employing treatment techniques which promote stretch and flexibility to the tendon.

Achillies tendon pain can also be attributed to the biomechanics of the foot. Should your therapist feel this is a causative factor they will be able to refer you to an orthotist who will undertake a more comprehensive assessment of your foot and gait pattern. Should it be required they can provide custom made insoles (orthotics) to help improve foot posture, reducing force through the tendon.