What is Achilles tendinopathy?
Achilles tendinopathy is an irritation of the Achilles tendon, a thick band of tissue along the back of the lower leg that connects the calf muscles to the heel. The term “tendinopathy” refers to any problem with a tendon, either short- or long-term. The Achilles tendon transmits force from the calf muscles down to the foot when a person pushes the foot off the ground (e.g., runs or jumps), and helps control the position of the ankle when the foot touches back down on the ground (e.g., lands). Achilles tendinopathy results when the demand placed on the Achilles tendon is greater than its ability to function. The condition can occur after a single incident (acute injury) or after repetitive irritation or “microtrauma” (chronic injury). Most often, Achilles tendon pain is the result of repetitive trauma to the tendon that can result in chronic Achilles tendinopathy—a gradual breakdown of the tissue—and is most often treated with physiotherapy.
Achilles tendinopathy is linked to several different factors, including:
- Calf muscle tightness
- Calf muscle weakness
- Abnormal foot structure
- Abnormal foot biomechanics
- Improper footwear
- A change in an exercise routine or sport activity
Pain can be present at any point along the tendon; the most common area to feel tenderness is just above the heel (known as midportion Achilles tendinopathy), although it may also be present where the tendon meets the heel (known as insertional Achilles tendinopathy).
With Achilles tendinopathy, you may experience:
- Tenderness in the heel or higher up in the Achilles tendon with manually applied pressure
- Pain and stiffness with walking, at its worst with the first several steps
- Tightness in the calf
- Swelling in the back of the ankle
Your physiotherapist will review your medical history and complete a thorough examination of your heel, ankle, and calf. Your physiotherapist will assess your foot posture, strength, flexibility, and movement. This process may include watching you stand in a relaxed stance, walk, squat, step onto a stair, or do a heel-raise. The motion and strength in other parts of your leg also will be assessed.
Your physiotherapist may also ask questions regarding your daily activities, exercise regimens, and footwear, to identify other contributing factors to your condition.
Imaging techniques, such as X-ray or MRI, are often not needed to diagnose Achilles tendinopathy. Although it is unlikely that your condition will ultimately require surgery, your physiotherapist will consult with other medical professionals, such as an orthopaedist, to determine the best plan of treatment for your specific condition if it does not respond to conservative care.
How Can a Physiotherapist Help?
Physiotherapy promotes recovery from Achilles tendinopathy by addressing issues such as pain or swelling of the affected area, and any lack of strength, flexibility, or body control. You and your physiotherapist will work together to develop an individualized treatment program to help you achieve your specific goals in the safest and most effective way possible. Your treatment may include:
Your physiotherapist will work with you to identify any possible external factors causing your pain, such as faulty footwear or inappropriate movements or exercises. Your physiotherapist will assess your footwear and recommend improvements and develop a personalized exercise program to help ensure a pain-free return to your desired activities.
Many pain-relief strategies may be implemented, such as applying ice to the area, putting the affected leg in a brace, using heel lifts, or using therapies such as iontophoresis (a medicated patch placed on the skin that is electrically charged and used to decrease pain and inflammation), or therapeutic ultrasound. These strategies can reduce the need for pain medication, including opioids.
Your physiotherapist may apply hands-on treatments to gently move your muscles and joints in order to improve their motion and function. These techniques often address areas that are difficult to treat on your own.
Your ankle, foot, or knee joint may be moving improperly, causing an increased strain on the Achilles tendon. Self-stretching and manual therapy techniques (massage and movement) applied to the lower body to help restore and normalize motion in the foot, ankle, knee, and hip can decrease this tension and restore full range of motion.
Loading of the tendon (applying weight or resistance to it) through exercise is beneficial for recovery from Achilles tendinopathy. You may begin by performing gentle strengthening exercises in a seated position (e.g., pushing and pulling on a resistive band with your foot). You then may advance to exercises in a standing position (e.g., standing heel raises).
Muscle weakness or imbalance can result in excessive strain on the Achilles tendon. Based on your specific condition, your physiotherapist will design an individualized, progressive, lower-extremity resistance program for you to help correct any weakness-associated movement errors that may be contributing to your pain.
Once your pain eases and your strength and motion improve, you will need to safely transition back into more demanding activities. To minimize the tension placed on the Achilles tendon and your risk of repeated injury, it is important to teach your body safe, controlled movements. Based on your goals and movement assessment, your physiotherapist will create a series of activities that will help you learn how to use and move your body correctly to safely perform the tasks required to achieve your goals.
If additional interventions are needed
Such as injections, minimally invasive tendon procedures, or surgery, your physiotherapist will work with you after your procedure to help you regain motion, strength, and function.
Can this Injury or Condition be Prevented?
Maintaining appropriate lower-extremity mobility and muscular strength and paying particular attention to your exercise routine—especially changes in an exercise surface, the volume of exercises performed, and your footwear—are the best methods for preventing Achilles tendinopathy.
When you have experienced an injury, your physiotherapist will help guide you through a process that will progressively reintegrate more demanding activities into your routine without aggravating your Achilles tendon. Keep in mind that returning to high-level activities too soon after injury can lead to another episode of pain.