The Achilles tendon runs down the back of the ankle, joining the calf muscle to the heel. It increases the efficiency of the calf muscles’ ability to propel you when walking, running or jumping. Achilles tendinopathy is the process whereby the tendon gradually becomes painful and sometimes thickened. Sometimes the pain will also be felt in the heel, where the tendon attaches.
Common factors associated with the development of this issue:
Recent change in overall load/activity including new or increased exercise load (Kountouris & Cook, 2007)
Increase in ‘explosive’ activities i.e. running/jumping (P. Malliaras & O’Neill, 2017)
Ankle stiffness (Rabin, Kozol, & Finestone, 2014)
Calf muscle weakness (McAuliffe et al., 2019)
Less common factors:
Biomechanical problems such as feet or knees that roll ‘inwards’ under load and weakness of other lower limb muscles may also sometimes be implicated
Some general health issues including high BMI, increased blood glucose and metabolic disease (Abate, Di Carlo, Salini, & Schiavone, 2014)
Genetics have been identified as a possible factor but more research is required in this area (Magra & Maffulli, 2008)
Patients with Achilles tendinopathy often complain of pain that is present first thing in the morning or after resting, that improves during exercise and returns when cooling down (P. Malliaras, Purdam, C., 2019). The tendon itself is usually tender to the touch and may look thicker than the tendon on the other leg (Hutchison et al., 2013). In advanced cases pain can begin to severely affect strength and performance of activities.
Treatment from your Physiotherapist will involve:
Education about the condition including how much pain is acceptable to continue moving/training through
Provision of strategies to reduce pain and manage flare ups
Exercises to strengthen the calf muscle and improve the tendon’s ability to take load
Assessing and addressing any other relevant lower limb biomechanical issues
Hands on treatment
Provision of foot orthotic supports
Your Physiotherapist will also liaise with any health professionals currently giving you treatment and, where appropriate, refer you to other professionals as required.
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