How to Best Manage Achilles Tendonitis

When Jenny's daughter Pheobe presented at the clinic with growing pains, it was bit suspicious that the "growing pains' were only in the one heel. So was it growing pains or something else?

After a few questions, it seemed quite obvious that Pheobe was suffering from "too much too soon" as her cross country and netball training were being ramped up.

After a thorough investigation, her main symptoms were related to Achilles tendonitis.

What is Achilles Tendonitis?

Achilles Tendonitis is a term that commonly refers to an inflammation of the Achilles tendon or its covering. It is an overuse injury that is common especially to joggers and jumpers, due to the repetitive action and so may occur in other activities that requires the same repetitive action.

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually it is the result of many tiny tears to the tendon that have happened over time.

Health professionals may use different terms to describe a tendon injury. You may hear:

Tendinitis (or Tendonitis): This actually means "inflammation of the tendon," but inflammation is rarely the cause of tendon pain.
Tendinosis: This refers to tiny tears in the tissue in and around the tendon caused by overuse.

Most experts now use the term tendinopathy to include both inflammation and micro-tears. But many doctors may still use the term tendinitis out of habit.

Achilles tendonitis is an overuse injury that is common especially to joggers and jumpers, due to the repetitive action and so may occur in other activities that requires the same repetitive action.

Achilles tendonitis may be felt as a burning pain at the beginning of activity, which gets less during activity and then worsens following activity. The tendon may feel stiff first thing in the morning or at the beginning of exercise. You will often feel a tender swollen area in the tendon.

Anatomy of your Achiiles Tendon

The calf muscles of the lower leg become the Achilles tendon. This is the prominent tendon at the back of the heel, which attaches to the heel bone.

These muscles are responsible for actions such as pointing the toes and standing tiptoe. They are greatly involved in repetitive activities such as walking, jogging, hopping and aerobics.

What Causes Achilles Tendonitis?

Over-training or unaccustomed use – “too much too soon”
Sudden change in training surface – e.g. grass to bitumen
Flat (over-pronated) feet
High foot arch with tight Achilles tendon
Tight hamstring (back of thigh) and calf muscles
Toe walking (or constantly wearing high heels)
Poorly supportive footwear
Hill running
Poor eccentric strength

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or ageing. Anyone can have a tendon injury, but people who make the same motions over and over in their jobs, sports, or daily activities are more likely to damage a tendon.

A tendon injury can happen suddenly or little by little. You are more likely to have a sudden injury if the tendon has been weakened over time.

What are the Symptoms of Tendinopathy?

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.
The pain may get worse when you use the tendon.
You may have more pain and stiffness during the night or when you get up in the morning.
The area may be tender, red, warm, or swollen if there is inflammation.
You may notice a crunchy sound or feeling when you use the tendon.

The symptoms of a tendon injury can be a lot like those caused by bursitis.

What's the Worst that Can Happen with an Achilles Tendonitis?

The worst case scenario is a total rupture of the tendon.

Treatment in this case usually requires surgery, plaster or a walking boot for at least six weeks.

Most of these injuries take six months or more to adequately rehabilitate.

The best advice is to seek early advice from your physiotherapist to do all you can to avoid this nasty rupture happening in the first place.

How to Treat Achilles Tendonitis

Achilles tendonitis is one of the most common problems that we see at PhysioWorks and it is unfortunately an injury that often recurs if you return to sport too quickly – especially if a thorough rehabilitation program is not completed.

Your calf muscle is a large powerful group of muscles that can produce sufficient force to run, jump and hop. Your Achilles tendon attaches your calf muscle to your heel bone. It is a tendon or non-contractile soft tissue structure, which does have a different level of blood supply and function, which does alter the rehabilitation from a calf muscle tear.

Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence – these are: