Achilles Tendonitis

The Achilles tendon is the large tendon which attaches your calf muscle (gastrocnemius) into the heel. This tendon contracts to allow the push off phase of walking or running or any toe pointing movement. A sudden movement could cause a violent ruputure of this tendon which may require surgical repair depending on the severity of the trauma.

Achilles tendonitis is a chronic overuse injury. The initial stages begin as a general irritation of the tendon. Degneration of the tendon and loss of the tendons collagen fibres cause the body to produce scar tissue in an attempt to heal. This causes a thickening of the tendon and an increase of pain.

Symptoms of Achilles Tendonitis

• Gradual onset of pain at the back of the ankle, just above the heel bone.
• Pain during exercise-may be constant or only during initial stages depending on severity
• Pain eases with rest.
• Tenderness on palpation.
• Pain in the tendon when walking especially up hill or up stairs.
• Pain and stiffness in the Achilles tendon especially in the morning or after rest.
• There may be nodules or lumps in the achilles tendon, particularly 2-4cm above the heel.
• Swelling or thickening over the Achilles tendon.

Causes of Achilles Tendonitis:

Achilles tendonitis is an overuse injury. Too much too soon is the basic cause of overuse injuries, however other factors can contribute to developing the condition.

• Increase in activity (either distance, speed or hills).
• Less recovery time between activities.
• Change of footwear or training surface.
• Weak calf muscles.
• Decreased range of motion at the ankle joint, usually cause by tight calf muscles.
• Running up hills - the achilles tendon has to stretch more than normal on every stride. This is fine for a while but will mean the tendon will fatigue sooner than normal.
• Overpronation or feet which roll in when running can place an increased strain on the achilles tendon. As the foot rolls in (flattens) the lower leg also rotates inwards which places twisting stresses on the tendon.
• Wearing high heels constantly shortens the tendon and calf muscles. When exercising in flat running shoes, the tendon is stretched beyond its normal range which places an 'abnormal' strain on the tendonOveruse of the Achilles tendon in activities involving distance and hill running, jumping

Treatment:

• Rest—rest is an important part of any over use injury. Rest gives the area a chance to heal and relief from the irritation causing the problem
• Ice—ice will help with pain control and inflammation of the tendon
• Physiotherapy --The physiotherapist will perform an evaluation of the affected area to determine the best course of treatment. Treatment will focus on pain relief, restoration of movement and proper foot/ankle mechanics to ensure full and proper weight bearing is occurring. Modalities (ie. Ultrasound, acupuncture), massage therapy and stretching/strengthening may be used.