Achilles tendinopathy

Achilles tendinopathy refers to pain in the Achilles tendon. The Achilles tendon is a thick band which connects the calf muscles to the heel. This tendon is placed under significant load during sports involving repeated impact work, especially jumping movements. However, many non-sports men and women can also develop an Achilles tendinopathy due to repetitive activities.

An Achilles tendinopathy can be reliably diagnosed by your doctor or physiotherapist by taking a history of your condition. In some circumstances it may be necessary to conduct a physical examination but this is usually not necessary initially in uncomplicated Achilles tendinopathy.

The main feature on examination is often pain and thickening of the Achilles tendon when palpated.

X-rays and scans are not routinely required.

Pain is felt directly over the Achilles tendon and is often associated with a thickening of the tendon. Sometimes pain is felt over the back of the heel which is referred to as an insertional Achilles tendinopathy. Symptoms are aggravated by any activity which requires repeated use of the calf muscles such as walking and running. Often the most severe symptoms will be felt not at the time of these activities but the following morning when the Achilles tendon has developed stiffness overnight.

It is possible for the Achilles tendon to rupture as a sudden event. You may have felt a sudden sharp pain and/or heard a snap at the time of injury. In this case, you would be unable to stand on tiptoe, would walk with a flat foot and will notice severe swelling and bruising in the Achilles region. In this case, you should see your doctor as soon as possible, as early referral onwards usually results in better outcomes.

An Achilles tendinopathy can be managed very effectively by adhering to the following advice and exercise routine. It is worth bearing in mind that recovery can take several weeks.

Immediate management
Immediate management is aimed at reducing swelling and alleviating pain to allow rehabilitation to commence as early as possible following injury.

Apply a cold/ice pack to the painful area for 5-10 minutes every 2-3 hours,as tolerated, taking care to avoid any skin damage

You may wish to take painkillers such as paracetamol or use non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen gel or tablets (please read the leaflet or speak to your pharmacist to check that these are safe for you to use)

Ongoing management
An Achilles tendinopathy can be managed effectively by adhering to the following advice and exercise routine:

Modifying aggravating activities
The Achilles tendon may need 4-6 weeks of relative rest initially to settle symptoms while you work on strengthening the calf muscles and Achilles tendon (see below).

Exercises
Regular exercises to strengthen and stretch the calf muscles and Achilles tendon:

3 x 15 repetitions 2x per day

3×10 repetitions 3-4x per week

These are suggested exercises only. If you are at all concerned about whether these exercises are suitable for you or if you experience any pain while doing them, please seek appropriate clinical advice from your GP or Physiotherapist.

Footwear
You should ensure that you use well-fitting, supportive footwear with adequate arch support, both during your everyday activities and, particularly, during exercise. Very flat shoes and high heels can also exacerbate the problem. Orthotic inserts placed inside your shoes can further reduce the load placed on the Achilles tendon.

Shockwave therapy
This may be offered as a treatment option for individuals with persistent pain in spite of undergoing a full course of physiotherapy.