What is Achilles Enthesopathy

Achilles Enthesopathy is a condition that affects the Achilles tendon, which connects the calf muscles to the heel bone. This condition causes pain and irritation where the tendon attaches to the heel. 

Common symptoms of Achilles enthesopathy include:

• Pain: Especially at the back of the heel, which may worsen with activity or as the day comes to an end.

• Swelling: Around the heel and lower calf.

• Stiffness: Particularly noticeable in the morning or after periods of inactivity.

• Tenderness: When touching the affected area.

How frequent is it and what are my chances of having it?

How likely you are to get this varies on your activity.

• General Population: The rate of Achilles tendinopathy in the general population is about 2.01 per 1,000 registered patients, or 0.2%.

• Athletes: Competitive athletes have a lifetime incidence of Achilles tendinopathy of approximately 24%, with 18% of these cases occurring in athletes younger than 45 years old.

• Recreational Runners: Achilles tendinopathy accounts for 6-17% of all running injuries.

What Causes Achilles Enthesopathy?

Achilles enthesopathy can be caused by several factors, including:

• Inflammatory conditions: Conditions like Arthritis can contribute to the development of enthesopathy.

• Overuse: Repetitive stress from activities like running or jumping.

• Injury: Trauma to the tendon or heel.

• Poor biomechanics: An abnormal foot structure or walking pattern can increase the stress on the Achilles tendons.

Are you Aware of the Risk Factors?

Several factors can contribute to the development of Achilles enthesopathy:

• Inflammatory conditions: Conditions like Arthritis can cause inflammation at the tendon attachment.

• Athletic overuse: High-impact sports and activities that involve running or jumping can increase the risk.

• Footwear issues: Wearing shoes with inadequate support or improper fit can contribute to the condition.

• Prolonged tension: Repeated pulling of the Achilles tendon on the heel bone can lead to inflammation and pain.

• Sedentary lifestyle: Lack of physical activity can cause the calf muscles to shorten, increasing stress on the Achilles tendon.

• Obesity: Excess body weight can put added strain on the Achilles tendon.

• Age: The risk of developing Achilles enthesopathy increases with age.

• Medication: Certain antibiotics, such as fluoroquinolones, can increase the risk of tendon problems.

Sporting Demands and Enthesopathy

Certain sports and physical activities can place significant stress on the Achilles tendon, increasing the risk of developing enthesopathy:

• Running: Long-distance running or sprinting can cause repetitive strain on the Achilles tendon.

• Jumping sports: Activities like basketball, volleyball, and gymnastics involve frequent jumping, which can stress the tendon.

• Tennis and racquet sports: The quick, explosive movements needed in these sports can lead to overuse injuries.

• Rugby, Hockey and  football: These sports involve sudden changes in direction and high-impact movements that can strain the Achilles tendon.

When to See a Physiotherapist

It's important to seek professional help if you experience symptoms of Achilles enthesopathy. You should see a Physiotherapist if:

• Pain persists: If you have ongoing pain in your Achilles tendon that doesn't improve with rest.

• Swelling and stiffness: Noticeable swelling or stiffness in the heel or lower calf.

• Difficulty with activities: Pain or discomfort that interferes with your daily activities or sports.

• No improvement: If self-care measures like rest, ice, and over-the-counter pain relievers aren't helping.

Early intervention can help prevent the condition from worsening and promote a quicker recovery.

Prevention Strategies

Preventing Achilles enthesopathy involves adopting healthy habits and practices to reduce the risk of developing the condition:

• Warm-Up and Stretching: Always warm up before engaging in physical activities and incorporate stretching exercises for the calf muscles and Achilles tendon.

• Proper Footwear: Wear shoes that provide adequate support and cushioning, especially during sports and exercise.

• Gradual Increase in Activity: Avoid sudden increases in the intensity or duration of physical activities. Gradually build up your activity levels to allow your body to adapt.

• Strengthening Exercises: Regularly perform exercises to strengthen the calf muscles and improve flexibility. This can help reduce stress on the Achilles tendon.

• Maintain a Healthy Weight: Keeping a healthy weight can reduce the strain on your Achilles tendon.

• Avoid Overuse: Take breaks and avoid repetitive high-impact activities that can strain the Achilles tendon.

• Listen to Your Body: Pay attention to any signs of pain or discomfort in your Achilles tendon and seek early intervention if needed.

Treatment Options at Relive Physiotherapy

At Chester’s Best Treatment Centre for Achilles Pain, Relive Physiotherapy, a variety of advanced treatment options are available to help manage and improve the symptoms of Achilles enthesopathy:

1. Manual Therapy - Hands-on techniques, including massage and joint mobilisation, can help improve circulation, reduce pain, and enhance mobility.

2. Shockwave Therapy - This non-invasive treatment uses sound waves to stimulate healing in the affected tendon. It can help reduce pain and improve mobility.

3. Ultrasound Therapy - Ultrasound therapy uses high-frequency sound waves to penetrate deep tissues, promoting healing and reducing inflammation.

4. Acupuncture - Acupuncture involves inserting thin needles into specific points on the body to relieve pain and promote healing. It can be effective in managing chronic pain associated with enthesopathy.

5. Injection Therapy - This involves injecting medications, such as corticosteroids, directly into the affected area to reduce inflammation and pain.

6. Exercise Therapy - Tailored exercise programs can help strengthen the calf muscles and improve flexibility, reducing stress on the Achilles tendon.

7. Customised Insoles - Custom orthotic insoles are designed to provide support and correct biomechanical issues that may contribute to Achilles enthesopathy. These insoles are tailored to fit your feet and can help distribute pressure more evenly, reducing strain on the Achilles tendon.

Prevention Strategies

Preventing Achilles enthesopathy involves adopting healthy habits and practices to reduce the risk of developing the condition:

• Warm-Up and Stretching: Always warm up before engaging in physical activities and incorporate stretching exercises for the calf muscles and Achilles tendon.

• Proper Footwear: Wear shoes that provide adequate support and cushioning, especially during sports and exercise.

• Gradual Increase in Activity: Avoid sudden increases in the intensity or duration of physical activities. Gradually build up your activity levels to allow your body to adapt.

• Strengthening Exercises: Regularly perform exercises to strengthen the calf muscles and improve flexibility. This can help reduce stress on the Achilles tendon.

• Maintain a Healthy Weight: Keeping a healthy weight can reduce the strain on your Achilles tendon.

• Avoid Overuse: Take breaks and avoid repetitive high-impact activities that can strain the Achilles tendon.

• Listen to Your Body: Pay attention to any signs of pain or discomfort in your Achilles tendon and seek early intervention if needed.

If you leave your problem too long, it can get worse, even becoming chronic, meaning that it will take a lot longer to heal.  The best thing to do is to consult early, as you will end up slashing your recovery time in comparison to what would have happened if you had done nothing.  

If you are suffering from Achilles Pain, then coming to see one of our Expert Achilles Pain Physiotherapists is one of the best things that you could possibly do.  When you come for your assessment, we will give you a thorough examination and build an individual treatment plan which is tailored to your needs.  We will support you every step of the way using a variety of different techniques, and explain the different stages of your recovery, and why you might think that you are better, but are, in fact, not!