Ankle Pain - What is Achilles Tendinopathy

Understanding Achilles Tendinopathy

The Achilles tendon, the largest and strongest tendon in the human body, plays a crucial role in helping us walk, run, jump, and perform many other physical activities. Located at the back of the lower leg, it connects the calf muscles (gastrocnemius and soleus) to the heel bone. Despite its strength, the Achilles tendon can be easily injured and one of the most common is Achilles tendinopathy.

Achilles tendinopathy refers to a condition that affects the Achilles tendon, typically caused by overuse or general wear and tear. It can result in pain, swelling, and limited mobility, which, if not treated properly, may affect your ability to participate in regular physical activities. 

What is Achilles Tendinopathy?

Commonly referred to as "tendinitis" when inflammation is involved, it can also be a more degenerative condition – the tendon fibres become frayed and weakened over time. This degeneration is often due to repetitive stress or overuse, particularly in athletes or people who frequently do activities like running, jumping, or dancing.

There are two main types of Achilles tendinopathy:

• Mid-portion Achilles Tendinopathy: This type of tendinopathy occurs in the middle section of the tendon, between the calf muscles and the heel bone.
  
  
• Insertional Achilles Tendinopathy: This type occurs where the tendon attaches to the heel bone, and it is often associated with more severe symptoms and complications.

Causes of Achilles Tendinopathy

Achilles tendinopathy is most commonly caused by repetitive stress on the tendon. However, several factors can contribute to the development of this condition:

1. Overuse or Overtraining: A sudden increase in physical activity, particularly in sports that involve running, jumping, or repetitive movements, can place excessive strain on the tendon, leading to tendinopathy.
   
   
2. Improper Footwear: Wearing shoes that do not provide proper support or cushioning can place additional stress on the Achilles tendon, increasing the risk of injury.
   
   
3. Tight Calf Muscles: If the calf muscles are tight, they can place extra tension on the Achilles tendon, contributing to its wear and tear.
   
   
4. Age and Degeneration: As we age, the tendon loses its elasticity, making it more prone to injury. Tendon degeneration is more common in people over the age of 30.
   
   
5. Biomechanical Issues: Abnormal walking patterns, poor posture, or leg length discrepancies can increase the strain on the Achilles tendon.
   
   
6. Previous Injury: A previous Achilles tendon injury or a history of tendinopathy can increase the likelihood of future issues with the tendon.

Symptoms of Achilles Tendinopathy

The symptoms of Achilles tendinopathy can vary depending on the severity of the condition. Some of the most common signs include:

• Pain and Tenderness: Pain in the Achilles tendon, especially after physical activity, is one of the most noticeable symptoms. The pain may be mild at first but can worsen over time.
  
  
• Stiffness: Stiffness in the tendon, particularly after periods of rest, such as in the morning, is common.
  
  
• Swelling: Swelling around the tendon or at the heel may occur, especially during flare-ups.
  
  
• Thickening of the Tendon: In more chronic cases, the tendon may appear thickened or enlarged due to degeneration.
  
  
• Limited Range of Motion: Difficulty bending or pointing the foot due to pain or stiffness in the tendon.

It’s important to note that Achilles tendinopathy pain often comes on gradually over time, and doesn’t occur suddenly unless there has been a specific trauma injury. During the early stages, the pain may be felt only after physical activity, but as the condition progresses, the pain can persist even while you are resting.

Treatment for Achilles Tendinopathy

The good news is that most cases of Achilles tendinopathy can be treated with non-invasive methods. Early intervention and proper care are key to avoiding more severe injuries, such as tendon rupture. Treatment options include:

1. Physiotherapy: At Chester’s Best Clinic for Foot, Ankle and Leg Pain, Relive Physiotherapy, we will offer you a holistic, tailored plan.  To see exactly what these are, please see the section below which outlines the different options.
   
   
2. Rest and Activity Modification: One of the important steps in treating Achilles tendinopathy is to reduce the frequency and intensity of the activity that is causing pain to your tendon. This might mean temporarily switching to low-impact exercises such as swimming or cycling to allow the tendon to heal.
   
   
3. Ice and Compression: Applying ice to the affected area for 15-20 minutes several times a day can help reduce inflammation and swelling. Compression with an elastic bandage can also provide support and reduce swelling.
   
   
4. Footwear Modifications: Ensuring proper footwear that provides proper arch support and cushioning can help reduce the strain on your Achilles tendon. In some cases, custom orthotics may be recommended to correct any biomechanical issues.
   
   
5. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter pain medicine, such as ibuprofen, can help reduce pain and inflammation in the short term. However, you need to be sensible about using these.
   
   
6. Corticosteroid Injections: In some cases, a corticosteroid injection may be recommended to reduce inflammation, though this is generally used as a last resort but has shown to provide almost instant relief from long term pain.
   
   
7. Surgery: If  the conservative treatment options don’t work, and the tendon shows significant degeneration or tears, surgery may be necessary. Surgical options include tendon debridement (removal of damaged tissue) or tendon repair.

Treatment Options at Relive Physiotherapy for Achilles Tendinopathy

At Relive Physiotherapy, we offer a holistic, comprehensive approach to treating Achilles tendinopathy. Our goal is not only to provide pain relief but also to help you recover fully, strengthen the affected tendon, and prevent future injury. We use a combination of advanced, evidence-based treatments tailored to your specific needs. 

1. Manual Therapy
   Manual therapy involves hands-on techniques performed by our skilled Physiotherapists to address pain, stiffness, and muscle imbalances around the Achilles tendon. Techniques like deep tissue massage, myofascial release, and joint mobilisations help reduce muscle tension, improve blood circulation, and restore proper movement patterns. Manual therapy is tailored to each patient, ensuring that the treatment you receive targets the source of pain and works in harmony with other rehabilitation techniques.
   
   
2. Ultrasound Therapy
   Ultrasound therapy is an effective non-invasive treatment that uses high-frequency sound waves to increase blood flow to the affected tendon, promoting healing and reducing inflammation. The sound waves penetrate deep into the tissue, enhancing cellular repair and reducing pain and stiffness. This therapy also helps with soft tissue relaxation, improving flexibility and mobility in the Achilles tendon. Ultrasound therapy is a great complement to other treatments and is often used as part of a broader rehabilitation plan.
   
   
3. Customized 3D Insoles
   For those suffering from Achilles tendinopathy, the right footwear support can make a significant difference. At Relive Physiotherapy, we offer customised 3D printed insoles to improve your posture, alignment, and foot mechanics. These orthotics are specially designed using 3D scanning technology to ensure a perfect fit, providing targeted support to relieve pressure on the Achilles tendon. Customised insoles can help redistribute forces while walking, running, or doing other physical activities, minimising strain on your tendon and preventing further injury. They are particularly beneficial for those with foot imbalances or improper gait patterns that make Achilles tendon issues worse.
   
   
4. Acupuncture
   Acupuncture is a highly effective treatment for managing Achilles tendinopathy, especially when dealing with chronic pain. Our qualified Physiotherapy Acupuncturists use thin needles inserted into specific points along the body to reduce inflammation, reduce pain, and promote circulation to the affected tendon. This treatment encourages your body’s natural healing mechanisms, helping to reduce tendon stiffness and improve mobility. Acupuncture is especially beneficial for addressing pain and restoring function, and is often used in conjunction with other therapies for optimal results.
   
   
5. Shockwave Therapy
   Shockwave Therapy, or extracorporeal shock wave therapy (ESWT), is an advanced, non-invasive technique used to treat chronic tendon issues, including Achilles tendinopathy. This therapy involves the application of high-energy sound waves to the affected tendon, stimulating circulation and accelerating the healing process. Shockwave Therapy promotes tissue healing, reduces pain, and breaks down scar tissue. It is particularly effective for people who have not responded well to traditional treatments. This treatment option has shown promising results in improving tendon strength and flexibility.
   
   
6. Injection Therapy
   For more severe cases of Achilles tendinopathy, Injection Therapy may be considered. At Relive Physiotherapy, we offer Corticosteroid Injections to reduce inflammation Injection therapy is often used when conservative treatments are not working, providing significant relief and aiding in the healing process.
   
   
7. Exercise Therapy
   Exercise therapy is a cornerstone of treatment for Achilles tendinopathy, focusing on strengthening the tendon and surrounding muscles to improve function and prevent re-injury. At Relive Physiotherapy, we provide strengthening exercises, which are proven to help heal tendons by promoting collagen synthesis and reducing tendon load. These exercises aim to increase tendon strength, flexibility, and stability. Our Physiotherapists will guide you through a progressive program tailored to your specific condition, ensuring proper technique and gradual progression for optimal recovery.

Prevention of Achilles Tendinopathy

While not all cases of Achilles tendinopathy can be prevented, there are several measures you can take to reduce your risk:

• Warm Up Properly: Always warm up before engaging in physical activity to prepare your muscles and tendons for stress.
  
  
• Stretching and Strengthening: Incorporating calf stretches and strengthening exercises into your routine can help maintain tendon flexibility and strength.
  
  
• Gradual Increase in Activity: Avoid sudden increases in training intensity or volume. Gradually build up the frequency and duration of your workouts to avoid overloading the Achilles tendon.
  
  
• Wear Supportive Footwear: Choose shoes that offer proper arch support and cushioning, especially if you engage in high-impact activities.

Why Choose Relive Physiotherapy?

At Relive Physiotherapy, we are dedicated to providing personalised, cutting-edge care for individuals with Achilles tendinopathy. Our team of experienced Physiotherapists works closely with each patient to design a personal treatment plan, integrating various  options to ensure the best possible outcome. Whether you are seeking relief from chronic pain, rehabilitation following an injury, or prevention strategies to avoid future flare-ups, we have the expertise and resources to help you recover and thrive.

If you are experiencing symptoms of Achilles tendinopathy or want to learn more about how our treatments can support your recovery, Relive Physiotherapy is here to help. Contact us today to schedule an appointment and take the first step toward pain-free movement and a healthier, more active lifestyle!

Conclusion

Achilles tendinopathy can be a frustrating and painful condition, especially for active individuals. However, with the right approach to treatment and prevention, most people are able to recover fully and return to their normal activities. If you experience persistent pain in your Achilles tendon, it’s important to seek medical advice early to prevent further damage. By understanding the causes, symptoms, and available treatments, you can take steps to protect your Achilles tendon and keep your body moving freely and without pain.