Achilles tendinopathy is a brief term used to describe swelling, tightness and pain along the Achilles tendon, at the point of insertion onto the calcaneus (rearfoot bone). The Achilles tendon is a tough yet flexible tendon that runs down the back of the ankle and connects to the foot. Its main function is to allow the foot to plantarflex, allowing movements which are vital in activities such as running, walking and even climbing up stairs.
The Achilles tendon is the largest tendon is the whole body, this being because there is a great amount of pressure exerted upon the foot on a daily basis, which the tendon must adhere to. After repetitive use or trauma to the area, the tendon can become damaged and a common symptom is pain along the back of the ankle with stiffness when movement occurs. Swelling may be visible and the area may be warmer and tender upon palpation. This being because when damage is occurred to the area, the body initiates an inflammatory response in order to start the tissue repair and healing stage. Common signs of inflammation is heat, pain, redness and swelling in the area. Achilles tendinopathy is a degenerative condition, this meaning that the condition will worsen over time if no treatment is considered. If this is the case, pain would become more chronic and may cause limitations to perform daily activities, causing a strain on the quality of life of the patient.
There are many causes of Achilles tendinopathy however repetitive use and strain play a key role in the progress of the condition. Other factors such as foot type/posture, weight, age, activity type and intensity all have an effect upon the development of Achilles tendinopathy.
It is important to get the condition looked at by a health professional to ensure that the area does not worsen and to ensure that the Achilles tendon as not completely ruptured. A completely ruptured tendon would mean movement in the area is very minimal and pain and inflammation evident. If this is suspected, urgent medical attention is needed and surgical intervention may be considered.
A health care professional can diagnose Achilles tendinopathy with the use of specialist equipment and tests. The practitioner will palpate the area to determine the location of the pain and swelling which will aid in diagnosis. To further aid this, the use of diagnostic ultrasound or MRI can be considered to provide visual representation of the condition to which damage can be seen to the Achilles tendon. Special tests will be performed such as equinus testing; this is a simple movement test that relates to the range of motion available in the Achilles tendon and foot. An FPI (foot posture index) will also be evaluated to determine the cause of the condition. Generally, people who are flat footed or have a low arch profile tend to develop Achilles tendinopathy due to the excessive pronation that occurs in the foot, causing an increase in pressure upon the tendon.
When Achilles tendinopathy occurs, there are a diversity of treatment methods to deal with the condition. Conservative methods are generally considered prior to surgical intervention however if the tendon is completely ruptured, surgical intervention is necessary. Some conservative treatment are as listed:
- RICE (rest, ice, compression and elevation)
Most commonly, Achilles tendon problems arise from overuse so it is important to offload pressure of the area by resting it as much as possible, applying ice, compressing and elevating the area can aid in the reduction of swelling in the area.
- Stretching
When Achilles tendinopathy occurs, more often than not, the area tightens up and becomes stiff. By performing daily stretching exercises, the flexibility of the tendon increases, meaning less pressure is exerted onto it which can aid in pain relief. Calf exercises are generally the best method to achieve this flexibility but must be done daily in order to see improvement in the condition.
- Medication
Painkillers such as paracetamol or ibuprofen can be taken to reduce pain and inflammation. Ibuprofen is a type of medication that belongs to a group called NSAIDs (non- steroidal anti-inflammatory medication). This medication is effective short term relief of symptoms but does not treat the underlying cause of the condition. NSAIDs should not be taken consecutively after 7 days, this can cause the healing potential of the area to decrease. People who have liver or heart problems should consult their doctor first before taking NSAIDs due to possible side effects.
- Orthotics
The most common cause of Achilles tendinopathy is a low arch profile or excessive pronation in the feet. An orthotics, whether it be custom made or prefabricated, aim to realign the foot into a neutral position meaning pressure is evenly distributing throughout the foot and surrounding structures. Orthotics do not immediately resolve symptoms but the long term prognosis when using this treatment method is very promising and ensures that the underlying cause of the condition is dealt with.
- Shockwave therapy
Shockwave therapy is a fairly new and innovative conservative treatment option which has been found to have an 80% success rate in the treatment of conditions such as Achilles tendinopathy. Shockwave therapy consists of a number of session in which a probe is applied to the area for a short period of time (20-30 minutes). The probe emits sounds waves into the affected area. This causes blood vessels to become stimulated within the area and turnover of calcium deposits increase which in turn, increases the potential for healing. This treatment option is pain free and offers immediate pain relief after each session.
- Steroid injection
Corticosteroids area a branch of medication that acts as an anti-inflammatory mediator and to suppress the body’s immune system. When treating an Achilles tendon, the area is injected with corticosteroids to reduce the aim and inflammation in the area. This treatment method is used for short term relief however does not treat the underlying problem. Long term use can cause side effects such as thinning of the skin, infection risk, hyperglycaemia, hypertension and osteoporosis.
Achilles tendinopathy is a very common condition seen across a diversity of age groups. Although not life threatening, it can cause major discomfort and affect the quality of life in an individual to the point daily tasks can prove to be quite problematic. However it is important to remember that is condition is treatable and early diagnosis can increase the likelihood of the condition healing effectively and efficiently.
For further information and advice please contact Central FootClinic here
Blog compiled by Jay Maru, Podiatrist, Central FootClinic
