The feet are made up of 26 bones and more than 33 joints arranged in columns and arches that vary in stiffness and flexibility. The back of the foot is made up of the heel bone and the ankle. The joint that holds them together allows the foot to move from side to side. The heel is connected to the calf muscles in the lower leg by the Achilles tendon, which is the most important tendon for movement.
Achilles tendinopathy is the term used to describe pain in the Achilles tendon with daily or recreational activities. It has previously been called Achilles tendinitis or Achilles heel, but tendinopathy is now the preferred term. Achilles tendinopathy is often seen in patients who participate in regular sports such as running or football. However, it is also seen in those who are less active and those with other health conditions such as diabetes, a thyroid problem or those that take certain medications.
The patient with Achilles tendinopathy often reports pain during any activity that places load on the tendon. This may include walking, standing for longer periods or running. The patient often reports pain that is initially sore with activity, gradually improves, but then starts again when activity increases. The pain may be persistent and ongoing for some time. The patient often reports that their pain improves when they stop their sport or fitness activity, only to resume several weeks or months later when they look to start it again.
Achilles tendinopathy is an overuse condition. The patient often reports a history of increasing load on the tendon. This may be as a result of increasing the amount of running they do in a short space of time, playing an extra game of football a week or even starting a new job that involves more walking and standing. However, other patients, particularly those who do not take part in sports, may find it hard to recall any obvious change to their routine.
Achilles tendon pain is a result of certain cells in the tendon responding to changes in load and activity. The tendon itself is made of a material called collagen which provides the tendon with strength and stiffness. In Achilles tendinopathy, the tendon structure may change as a result of prolonged overuse, and this can result in temporary pain with certain activities. Cook & Purdam (2009) suggests improvement in function that occurs with exercises, despite the tendon changing in structure. Exercise makes the tendon, muscle-tendon complex, and the whole body tolerate the loads placed on them and can reduce pain.
Achilles tendinopathy is more commonly seen in those who are physically active on a regular basis including activities involving running and jumping. This condition has been show to affect up to 9% of recreational runners and it may end the careers in 5% of professional athletes.
A chronic, long-standing Achilles tendinopathy is more common in older populations. There are some groups of patents – such as those with diabetes, high cholesterol or those that take certain medications – that are more vulnerable to Achilles tendon pain with relatively low levels of activity.
At Pure, our Physiotherapists will take a detailed history of your symptoms and a comprehensive physical examination to produce an accurate and timely diagnosis. The sooner a definitive diagnosis is confirmed, the sooner an effective treatment and management plan can be put in place to facilitate optimal recovery and restore function.
Your clinician at Pure Physiotherapy will help guide you through the most appropriate treatment and management of your Achilles tendinopathy. The Physiotherapist will help work out a specific plan to modify activities which you may be struggling with due to your pain. The Physiotherapist can also answer any questions you may have about your pain, such as what is causing the pain and the likely recovery time with your rehabilitation programme. Throughout your recovery, you will be re-assessed to check your progress and to modify your treatment and management plan so that it remains highly effective and is targeted towards your personal goals.
Your Physiotherapist or Doctor may suggest that you supplement your exercises with other treatments such as massage of your calf muscles or orthotics that can be inserted into your footwear to alter the mechanics of your feet. It is also beneficial to strengthen other areas of the body (for example around the knee or hip).
Strengthening exercises are the most important treatment for Achilles tendon pain and your Physiotherapist will provide you with a bespoke and progressive home exercise programme, tailored to your goals. The aim of any exercise you may be given is to strengthen your calf muscles and Achilles tendon. These exercises, performed over time, improve the capacity of your tendon to deal with the stresses and strains of life (Murphy et al., 2018). There are various types of exercise that may be recommended to you. There are exercises that can be performed using gym equipment but also exercises that are easily performed at home. The provision of a personalised and progressive self-management and exercise plan equips you with the skills and knowledge to effectively manage your symptoms. We aim to provide ongoing support so that you are able to prevent re-occurrence.
Ben Bradford MSc BSc (Hons) MCSP
Cook, J. L. & Purdam, C. R. (2009). Is tendon pathology a continuum? A pathology model to explain the clinical presentation of load-induced tendinopathy. British journal of sports medicine, 43(6), 409-416.
Murphy, M., Travers, M., Gibson, W., Chivers, P., Debenham, J., Docking, S. & Rio, E. (2018). Rate of improvement of pain and function in mid-portion Achilles tendinopathy with loading protocols: a systematic review and longitudinal meta-analysis. Sports Medicine, 48(8), 1875-1891.