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Achilles Tendinopathy (formerly “Achilles tendinits”)
What is it?
Achilles tendinopathy refers to degeneration within the large tendon which joins
the calf muscles (gastrocnemius and soleus to the heel bone (calcaneus).
How does it happen?
Achilles tendinopathy results from overuse of the tendon. It is a common injury in sports involving running and
jumping.
The function of the calf muscle is to transmit forces produced by the calf muscles to the heel bone. Repetitive use of
the calf muscles and the Achilles tendon, leads to microscopic tears within the substance of the tendon.
To repair these microscopic tears, the body commences an inflammatory response.
Although this response is initially part of the healing process, when the stresses are repeated, the inflammation is
prolonged and so produces local tissue damage.
Factors which may contribute to Achilles tendinopathy include a recent change in
training (including frequency, duration, intensity, and training surfaces), reduced rest
times, poor footwear, biomechanical abnormalities, and decreased muscle flexibility and
joint range of motion. These factors can lead to increased stress on the Achilles tendon
and the development of Achilles tendinopathy.
How does it feel?
Achilles tendinopathy results in pain within the tendon just above where it attaches to the heel bone. This pain
typically develops gradually. Initially, the tendon may only be painful following exercise. For example it may be first
felt on rising the day after participation. Associated with the pain may be stiffness or tightness in the Achilles tendon.
Typically these initial signs of Achilles tendinopathy disappear quickly with walking about or applying heat (i.e. a hit
shower). However as you continue to participate, the tendinopathy progresses, and the pain with the tendon
becomes more intense and more frequent. It may now be present during exercise. Initially the pain during exercise
may initially disappear as you warm up, only to return when you cool down. As you continue to exercise, the
tendinopathy progresses and your pain may begin to be present for longer periods during exercise until it is present
all the time.
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What should you do?
Achilles tendinopathy generally does not get better on its own. If you have or suspect you have achilles tendinopathy
you should consult a physiotherapist.
How is it managed?
The assistance of a physiotherapist is important in the treatment of Achilles tendinopathy. Treatment involves
activity modification, soft tissue treatment such as massage and stretching, correction of your biomechanics using
orthoses, and the progression through a series of specific strengthening exercises. Anti-inflammatory medication
may necessary.
How long will it take to get better?
Every patient is different and can vary in their response to treatment depending on the severity of your injury, how
long you have had it for, and the presence of contributing factors. As this tendon has a poor blood supply recovery is
slow and can take 6 to 12 weeks for return to full participation in sport/exercise.
What can I do now that I’m receiving treatment?
It is important that you avoid performing the activities that aggravate your tendon such as running and participating
in sport, so that the cycle of inflammation and micortears can be stopped. In the acute stage it is important to get
rid of swelling that has arisen in the tendon. You can do this by regular icing. Ice can be applied wrapped in a moist
towel for 15-20 minutes or ice in a paper cup massaged up and down over the achilles region until the skin is numb.
You should perform the stretches and strengthening exercises your physiotherapist has given you on a regular basis,
as these will increase the strength in the tendon and stop you getting pain.
You should take anti-inflammatories as recommended by your physiotherapist or doctor.
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