The Achilles tendon is the largest tendon in the body and it connects the gastrocnemius and soleus (the calf muscles) to the heel bone.

There are different types of injuries to the Achilles tendon and surrounding structures. It is important before beginning management to ensure a correct diagnosis as management of a tendon injury is different to joints and other structures.

Different types of Achilles injuries include:

  1. Insertional Achilles tendinopathy – is a condition that occurs when the Achilles tendon attachment at the heel bone becomes inflamed or degenerated.
  2. Achilles tendinitis –  is an overuse injury that occurs when the tendon becomes inflamed due to repetitive stress.
  3. Achilles tendinosis –  is a degenerative condition that occurs when the tendon is chronically overused and has micro-tears that do not heal properly.
  4. Achilles tendon rupture –  is a sudden and complete tear of the tendon that can occur due to a forceful contraction of the calf muscles or a traumatic injury.
  5. Haglund’s deformity –  is a bony enlargement on the back of the heel that can irritate the Achilles tendon and cause pai

Achilles Tendinitis/tendinopathy

This is an overuse injury, therefore managing an Achilles tendinitis involves changing the load to the tendon with a specific loading program. It will often feel tight in the mornings or as you start to run/walk, however will warm up with activity. 

A carefully graduated exercise program will start with low load activities such as calf raises and progress to dynamic jumping and hopping exercises. These plyometric type exercises will prepare the tissue for the demands of the sport you play. 

The Achilles tendon acts like a spring, therefore complete rest will not fix the issue. When you stop loading the tendon, it makes the tendon become less capable of being a spring. This will then take longer for the tendon to return to normal strength. 

Complete rest and passive treatments alone will not fix the tendon. Whilst injections and medications can reduce the pain, they don’t help to restore the tendon’s strength or function. Whilst we want to load the tendon, we don’t want to stretch the tendon. Stretching the tendon places a compressive force on the tendon which will make the tendon more irritable.

A Podiatrist can help you load the tendon correctly and provide a thorough long term management plan. 

Once calf strength has reached capacity through calf raises, the Podiatrist will shift the focus to retraining its spring-like properties. As an example here are some great plyometric exercises to maximise the tendons potential to store and release energy from Tom at Mechanics of Movement.

Insertional Achilles Tendinopathy

The Achilles tendon connects the calf muscle to the heel bone and when the tendinopathy affects this area it is called insertional Achilles Tendinopathy. 

Symptoms may include:

  • Pain and tenderness at the back of the heel
  • Stiffness and difficulty walking/running
  • Pain may worsen with activity and improve with rest

Risk factors include:

  • Overuse or repetitive strain on the Achilles tendon
  • Inappropriate footwear
  • Tight calf muscles
  • Structural abnormalities of the foot and ankle

Treatment includes:

  • Activity modification
  • Physical therapy – such as dry needling and massage of the calf
  • Strengthening and mobility
  • Change to footwear
  • Heel lifts
  • In severe cases surgery may be needed 

Achilles tendon rupture

A rupture of the Achilles tendon is a sudden and complete tear which is commonly seen when jumping or running with sudden movements. 

It causes severe pain which is sudden at the back of the ankle. At the time of rupture a ‘pop’ or ‘snapping’ sound may be heard.

Treatment for an Achilles tendon rupture will depend on a few factors. Such as the severity of the injury, overall health of the patient and what their daily activities involve. At the time these factors will be assessed and it will be determined whether surgery or conservative measures will be used.  Recovery from an Achilles rupture can take months of rehabilitation to regain pre rupture strength with or without surgery.

Non-surgical treatments may include:

  • Immobilization with a cam walker and heel lift
  • Strengthening and physical therapy
Running with Achilles tendinopathy

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If you are suffering from heel pain or need help identifying what type of Achilles injury you have, we are here to help! Consult us to find out how best to treat your condition now.

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