Wow – If you have ever experienced pain in the Achilles you understand how it can get in the way of the activities you want to do and because of this it can get in your head and heart!
Achilles injuries are notoriously often long lasting injuries, this is because many of the treatment options available to people are focussed on the site of the problem, or solely about the pain.
This is pretty sad, because people will often modify their behaviour and lives to manage the problem long term and it DOESN’T have to be that way.
There is often a lot more occurring within the body with Achilles injuries. When these factors are addressed it is very easy to achieve a long term resolution for Achilles injuries.
I’ve had clients experiencing Achilles pain say things like:
“I think my football days are over.”
“I’ll just have to meet my friends for lunch from now on because I can’t manage going for a walk to catch up anymore.”
“I guess this is just part of getting older. I’ll have to do less from now on.”
This resource has been written for anyone wanting to know more about Achilles pain and especially for those people who are struggling to complete the physical activities that make them happy.
What is Achilles tendinopathy?
The Achilles tendon connects the muscles in the back of the leg to the heel bone. It is the strongest and thickest tendon in the body and has the potential to withstand very high amounts of load. The tendon is responsible for transferring force from the muscles in the back of the leg to the foot for actions such as propulsion. It can also absorb force from the ground in actions like walking or jumping, acting like a shock absorber.
Tendinopathy (sometimes interchangeable with “tendonitis” or simply referred to as “Achilles pain”) is a painful condition often associated with swelling (inflammation) within the tendon.
In more advanced and long standing cases, physical enlargement or a “bulge” around the tendon is something that can be seen obviously with the naked eye.
What are the symptoms of Achilles tendinopathy?
Pain
Some cases may be most painful at the attachment of the tendon to the heel bone and other cases may be more painful in the midportion of the tendon, or even higher up at the junction of tendon and muscle.
Pain often follows a predictable pattern where pain will increase with an increase of activity and after periods of rest. For example, people may say the following:
“I’ve had a big day on my feet and have done lots of walking. Now my Achilles is much more painful.”
OR
“The first few steps in the morning or after I’ve been sitting for a while are the most painful.”
Swelling
Swelling is a sign of Achilles tendinopathy, although may or may not be visually obvious in all cases.
Difficulty with movement
People with Achilles tendinopathy will often start moving differently to change the force throughout the tendon when walking. This can change the intensity of pain and make movement possible, although difficult. When this occurs, load is transferred to other structures in the body such as the knees, hips or back. If this behaviour is maintained long enough, it is likely a person experiencing Achilles tendinopathy will also experience other areas of pain in the body.
How is Achilles tendinopathy diagnosed?
Most people are diagnosed with Achilles Tendinopathy after visiting their doctor and after imaging such as MRI or ultrasound are completed. Following this, the doctor will often refer to a movement focused therapist such as a Podiatrist, Strength & Conditioning Coach or Physiotherapist for treatment.
It is helpful to know that imaging, such as MRI and ultrasound is not required to diagnose and begin treatment with a practitioner. A good therapist who has experience working with Achilles Tendinopathy can apply a wide range of physical tests within a consultation to diagnose, understand more about the causes of the Tendinopathy and begin treatment within the first session, without the need for further imaging.
For people experiencing multiple areas of pain, alongside Achilles Tendinopathy, such as foot, ankle, leg, knee, hip or back pain, it is advisable to consult with a Podiatrist for a biomechanical assessment.
What are the grades or degrees of severity of Achilles tendinopathy?
There are varying degrees of Achilles tendinopathy and different degrees of Achilles tendinopathy will attract different recommendations for management. The degrees of Achilles tendinopathy are:
Grade 1 / Mild
No pain during activity. Pain can present before or after activity. People experiencing a grade 1 injury will explain that their problem “warms up” and is pain free during activity.
Grade 2/ Moderate
Pain may be experienced during activity and some loss of function. People experiencing a grade 2 injury will explain an accommodation or changing of movement to prevent loading the tendon during movement.
Grade 3/ Severe
Most if not all standing and moving activities cause pain. People experiencing a grade 3 injury will often present with a limp and other sites of pain in the body as other areas of the body are likely to become overloaded with movement.
Who gets Achilles tendinopathy?
People of any age can experience Achilles Tendinopathy although it is common in active populations such as school aged children and adults.
What are the treatment options for Achilles tendinopathy?
Short term management of Achilles Tendinopathy are usually targeted at reducing pain and improving function.
This can include:
- Reducing the amount of provocative activities such as walking, running, playing sports etc.
- Wearing lace up shoes to refrain from excessive movement within the foot and ankle, leading to pain
- Using ice packs to reduce the swelling and pain
- Taking anti-inflammatory medication to reduce the swelling and pain
- In some cases, using crutches or protecting the area with a moon boot can be useful
Long Term Management
In Australia, it is common that management of Achilles tendinopathy is offered as rest, ice and medication alone (tablets or injections) without consideration of addressing the underlying cause of the problem. This is sad as people learn to avoid activities to manage the pain ongoing.
Successful long term management of Achilles Tendinopathy must begin with a thorough assessment and understanding of the influencing factors that have caused the problem.
A successful long term management plan will address the underlying cause of the problem and may include:
- Load/ activity management (in grade 3/ severe cases this may require use of crutches)
- Footwear advice/ consideration
- Orthotic therapy to influence biomechanics and gait (the particular way the foot is being loaded)
- Strength and conditioning exercises (to make the body stronger, influence movement and gait and prevent recurrence of injury)
By assessing thoroughly and understanding an individual’s specific loading patterns, a clear and specific treatment plan can be created and no two treatment plans ever look the same as people are different!
If you are interested in learning more about a specific management plan for you or someone you may know, read on to the helpful links and resources below.
Helpful Links and Resources
Please feel welcome to book an appointment here, or call us on (03) 52981147.
Understand and learn more with the following resources:
Written by:
Daniel Monteleone
Podiatrist / Strength & Conditioning Coach
