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Home > Physio's Blog > Achilles Tendonopathy

Achilles Tendonopathy

08.04.14 - As Spring and Summer beckon, many of us feel the pull of nature, attracting us to excercise outdoors.

For many of us this will result in pulling on those often worn but comfy trainers and hitting the road. Even for the trained elite athlete this can spell disaster if approached too enthusiastically, but for the lesser conditioned runner, the road vs the treadmill can be a dangerous place for joints and tendons.

Achilles tendonopathy is a condition that causes pain, swelling and stiffness of the Achilles tendon. This combination of symptoms often results in weakening of the tendon and sometimes complete rupture which can be catastrophic to future activity and function. Around 6 in every 100 inactive people will develop Achilles tendonopathy some time in their life time, however it has a higher incidence in athletes or people participating in a lot of exercise. It is more common in men than women and typically affects men between the ages of 30 and 45.

There is often very little, if any, active inflammation evident in the tendon unless there has been recent trauma - hence the term 'tendonitis' (inflammation) no longer being commonly used. The pain is caused by repeated micro traumas, resulting in the disruption of the collagen fibrils and ultimately the release of chemicals (neuro peptides) which irritate nerve endings. The inability of the tendon to heal before further injury is subjected to it causes degeneration.

Reasons for the damage to the tendon can be:

  • Excessive running and jumping on hard or sloped surfaces
  • Training in inappropriate/worn footwear
  • Poor running/training technique
  • Too rapid increase in training intensity or frequency
  • Poor tendon strength or flexibilityPoor biomechanics

How to avoid it developing

Pay attention to all of the above and try not to fall into their traps. Also,

Regular stretching of your tendon and calf region particularly after running and in the morning can improve it's flexibilityIt is important to ensure you have done preparatory strengthening of the muscles and tendons prior to embarking on a running fitness campaign. This should be continued alongside your running routine.Ensure you have relatively new trainers to run inSee a podiatrist who specialises in running biomechanics if you suspect a flat or excessively high arch to your foot

What are the symptoms?

Pain and stiffness at the back of the lower leg (achilles tendon)Gradual onset and often worse first thing in the morningIt can be sore during exercise but often one can 'run through it'Often associated with a swollen 'bump' on the tendon or a thickened appearance compared to the opposite side

What treatment is required?

Often the acute symptoms will settle with rest from high impact, regular icing for 10 mins/session and pain killersInvestigations are not normally required unless symptoms are unusually prolonged or a tear is suspected by your therapist or doctor (usually because of a more sudden onset). Ultrasound scan is the best method of diagnosing damage to the tendon or tendon sheathLocal treatments to the tendon by a chartered physiotherapist can significantly help, which may include ultrasound, interferential and hands on specific soft tissue mobilizationsA stretching and very specific tendon based strengthening programme often optimizes the recovery of the tendonInsoles may also be advocated if there are bio-mechanical malalignments or dysfunctions

Conservative treatment will usually clear up Achilles tendonopathy symptoms within 3-6 months. Due to the complex nature of the tendons healing abilities it is not unusual for it to take 6 months to go away.

However if symptoms remain after 6 months;

An ultrasound scan is advisableInjection therapy may be appropriate using either your own separated blood (autologous blood injection) or HVIGH (high volume image guided injections)Extra corpeal shock wave therapy (ESWT) is a new approach but little evidence is available yet as to its efficacySurgery may be an option for particularly stubborn cases

For more information and treatment advice please do not hesitate to contact us.