Achilles Tendinopathy (or Achilles Tendinitis)

Description:

The Achilles tendon is the largest and strongest tendon in the body. It is located in the back of the lower leg and connects the large calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). Achilles Tendinopathy is a degeneration of the Achilles tendon. It can be acute (due to one-time trauma) or chronic. Often the structures around the tendon become inflamed and the entire tendon becomes less flexible than healthy tendon. If left untreated, Achilles Tendinopathy can progress into a chronic condition. In some situations it may progress into a full rupture and surgery may be required.

Common Signs and Symptoms:

• Sudden or gradual onset of symptoms including:
  • Presence of an Achilles nodule,
  • Pain in the back of the leg and ankle, and
  • Decreased strength and mobility in the ankle.

Causes:

• Activity-related factors:
  • Activities that involve sudden starts and stops and repetitive jumping,
  • Sudden increases in activity, and
  • Decreased recovery time between exercise bouts.
• Equipment and surface issues:
  • Training on poor surfaces or up hills,
  • Changes in surface, i.e. running on trails vs. concrete sidewalks,
  • Switching from high heels to athletic shoes, and
  • Poor footwear, i.e. high heels, soft rearfoot.
• Biomechanical and anatomical factors:
  • Unhealthy pronation of the foot,
  • Limited ankle range of motion, and
  • Calf muscle weakness and inflexibility.

Preventative Measures:

• Appropriate warm-up and stretching before and after activity,
• Allowing for adequate rest and recovery between exercise bouts,
• Maintaining appropriate conditioning:
  • Calf muscle flexibility,
  • Muscular strength and endurance, and
  • Cardiovascular fitness.
• Proper footwear:
  • Replace running shoes every 500-800 kilometers.

Management:

• Ice to relieve pain,
• Stretching and strengthening exercises (eccentric heel drop),
• Activity modification, and
• Custom foot orthoses and footwear prescription.