Achilles tendinopathy is a common and often frustrating condition affecting the Achilles tendon, which connects your calf muscles to your heel bone.

This comprehensive guide aims to provide you with a deep understanding of Achilles tendinopathy, including its causes, symptoms, diagnosis, and treatment options, particularly focusing on physiotherapy.

By the end of this post, you’ll be well-equipped with the knowledge needed to manage this condition effectively.

Achilles tendinopathy is a disorder of the Achilles tendon characterised by pain, swelling, and impaired function.

Achilles tendinopathy usually occurs when the tendon becomes irritated due to overuse. This condition can affect anyone but is particularly common among athletes and individuals who engage in activities that place repetitive stress on the tendon.

There are 2 types of Achilles Tendinpathy. Each type will require slightly different treatment strategies to avoid aggravating the pain. However, the overall management will be similar. 

1. Mid-Portion Achilles Tendinopathy: This type involves the fibers in the middle portion of the tendon. It’s common among younger, more active individuals. You’ll feel the pain in the middle of the achilles tendon. 
2. Insertional Achilles Tendinopathy: This occurs at the point where the tendon attaches to the heel bone. It’s more common in older adults and can be associated with bone spurs. You’ll feel the pain at the base of the achilles tendon, at your heel. 

The primary reason why people develop an Achilles Tendinopathy is due to overload of the achilles tendon. This means that they’ve increased the intensity of their activity too quickly.

A common example is someone who has just started to pick up running and started to run 10km everyday. The dramatic increase in load will result in an overuse injury and likely an Achilles tendinopathy. 

Several factors contribute to the development of Achilles tendinopathy, including:

1. Overuse: Repetitive stress from high load activities like running, jumping, and dancing can result if you progress too quickly instead of being slowly progressed over time.

2. Footwear: Changing shoes can result in a change in biomechanics of your foot and ankle, therefore altering the load going through your Achilles tendon. This may be a factor contributing to you tendon pain. 

3. Training Errors: Abrupt increases in intensity or duration of physical activity can overwhelm the tendon.

4. Medical Conditions: Conditions like obesity, hypertension, and diabetes can significantly increase the risk of tendon injuries.

Recognising the signs and symptoms of Achilles tendinopathy is crucial for early intervention and effective treatment. The longer you leave your symptoms, before getting treatment, the harder it is to improve. 

Common symptoms include:

 1. Pain and Stiffness: Pain is typically felt at the back of the heel or along the tendon, especially after periods of inactivity or first thing in the morning.

2. Swelling: Swelling and thickening of the tendon may occur.

3. Tenderness: The tendon may be tender to touch.

4. Limited Range of Motion: You might have reduced ankle flexibility around the ankle.

5. Weakness: Decreased strength in the affected leg. This is especially true in the calf and foot muscles. However, sometimes you may also find weakness around the knee and hip.

Diagnosis of Achilles tendinopathy involves a combination of medical history and a physical examination.

It is usually unnecessary to perform any imaging tests, such as ultrasounds of MRI, to diagnose an Achilles tendinopathy. However, they may be helpful in ruling out other conditions if you aren’t progressing as expected or we suspect there is something else happening around the ankle joint that is causing your pain. 

Symptom History 

Your physiotherapist will ask about your symptoms, activity level, medical history and any recent changes in your exercise routine.

Most of the time, your history will give us a good indication if you have an Achilles Tendinopathy. 

Physical Examination

The physical examination is primarily used to confirm or deny our suspicion. During the physical examination, your provider will check for tenderness, swelling, strength and range of motion in your ankle.

For a true Achilles tendinopathy, your pain will get worse with increased loading of the Achilles tendon. 

Physiotherapy plays a crucial role in the treatment and management of Achilles tendinopathy.

A tailored physiotherapy program can help reduce pain, improve function, and prevent recurrence. 

Physiotherapy and progressive exercise is the primary method of treating an Achilles tendinopathy. 

Based on the assessment, a personalised treatment plan will be developed. This may include:

Pain Management: Techniques such as massage and Extracorporeal Shock Wave Therapy (ESWT) can help reduce pain in the short-term. It is important to note that the tendon does not adapt and grow stronger with these interventions and there are no long-term effects.

Stretching Exercises: To improve flexibility in the calf muscles and Achilles tendon if you have limited range of motion.

Strengthening Exercises: Heavy slow resistance training is the primary treatment method for an Achilles tendonpathy. We utilise heavy strength training to provide a stimulus for the tendon to adapt and grow stronger. If you are unable to tolerate heavy resistance exercise, we may start using isometrics or eccentric exercise training.

Activity Modification: You will be given guidance on modifying your activities to avoid aggravating the tendon.

If you’re struggling with Achilles tendinopathy, don’t let it hinder your daily activities and enjoyment of life. Contact us today to schedule a comprehensive assessment and personalised treatment plan.

Our experienced physiotherapists are here to help you recover quickly and prevent future injuries.

Call us now on (02) 4721 1222 or book an appointment online.

Prevention is key to avoiding the onset or recurrence of Achilles tendinopathy. Implementing the following strategies can help reduce the risk:

Gradual Progression: Gradually increase the intensity, duration, and frequency of physical activities to allow the tendon to adapt.

Strength and Flexibility: Incorporate calf-strengthening exercises and stretching into your regular exercise routine to maintain tendon health and flexibility.

Isometrics are great at promoting tendon stiffness and strength. Improving muscle strength in the calf muscles can also improve Achilles tendon function as generally people with an Achilles tendinopathy will have weak calf muscle strength. 

Cross-Training: Alternate high-impact activities (like running) with low-impact activities (like swimming or cycling) to reduce repetitive stress on the Achilles tendon.

1. Heel Drop Exercise (Eccentrics):

– Stand on a step with your heels hanging off the edge.

– Very slowly lower your heels below the step level.

– Rise back up to the starting position using both legs.

– Repeat this exercise for 3 sets of 8-10 repetitions daily.

– If it feels too easy, you can make it harder by holding onto a weight such as a dumbbell.

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.workoutsprograms.com%2Fexercises%2Feccentric-standing-calf-raises&psig=AOvVaw3d0xs0IKeO6W4WtFeuTOOa&ust=1719279314683000&source=images&cd=vfe&opi=89978449&ved=0CBEQjRxqFwoTCLjNotqM84YDFQAAAAAdAAAAABAE

2. Single Leg Calf Raise (Isometric):

– Have your hands on a bench or against the wall for support. 

– On two legs, rise up as high as you can onto your toes. 

– Lift one foot off the floor and hold it in the air. 

– Hold this position for 5 sets of 45 seconds daily. 

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.thephysiobot.com%2Ftag%2Fsingle-leg-isometric-calf-raise%2F&psig=AOvVaw32-wNz67zb4qh2tu0ia9CG&ust=1719279445771000&source=images&cd=vfe&opi=89978449&ved=0CBEQjRxqFwoTCOiu4ZqN84YDFQAAAAAdAAAAABAE

Achilles tendinopathy can be a painful and debilitating condition, but given the right amount of time and correct treatment, you can achieve a complete recovery. Understanding the causes, recognising the symptoms, and seeking early treatment are key to managing this condition effectively. Physiotherapy offers a range of treatments that can help alleviate pain, improve function, and prevent recurrence.

If you’re struggling with Achilles tendinopathy, don’t hesitate to reach out to our clinic. Our team of skilled physiotherapists is dedicated to providing personalized care to help you achieve a full recovery.