What is Achilles Tendonitis?

Achilles Tendonitis is a term that commonly refers to an inflammation of the Achilles tendon or its covering. It is an overuse injury that is common especially to joggers and jumpers, due to the repetitive action and so may occur in other activities that requires the same repetitive action.

Most experts now use the term Achilles tendinopathy to include both inflammation and micro-tears. But many doctors may still use the term tendonitis out of habit.

What Causes Achilles Tendonitis?

Achilles tendonitis is an overuse injury that is common especially to joggers and jumpers, due to the repetitive action and so may occur in other activities that requires the same repetitive action.

Common Causes of Achilles Tendonitis include:

  • Over-training or unaccustomed use – “too much too soon”
  • Sudden change in training surface – e.g. grass to bitumen
  • Flat (over-pronated) feet
  • High foot arch with tight Achilles tendon
  • Tight hamstring (back of thigh) and calf muscles
  • Toe walking (or constantly wearing high heels)
  • Poorly supportive footwear
  • Hill running.
  • Poor eccentric strength

What are the Symptoms of Achilles Tendonitis?

Achilles tendonitis may be felt as a burning pain at the beginning of activity, which gets less during activity and then worsens following activity. The tendon may feel stiff first thing in the morning or at the beginning of exercise.

  • Achilles tendonitis usually causes pain, stiffness, and loss of strength in the affected area.
  • The pain may get worse when you use your Achilles tendon.
  • You may have more pain and stiffness during the night or when you get up in the morning.
  • The area may be tender, red, warm, or swollen if there is inflammation.
  • You may notice a crunchy sound or feeling when you use the tendon.

 

What are the Aims of Achilles Tendonitis Treatment?

Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence.

Phase 1 – Early Injury Protection: Pain Reduction & Anti-inflammatory Phase

As with most soft tissue injuries the initial treatment is RICE – Rest, Ice, Compression and Elevation.

In the early phase you’ll be unable to walk without a limp, so your Achilles tendon needs some active rest from weight-bearing loads. You may need to be non or partial-weight-bearing,

Ice is a simple and effective modality to reduce your pain and swelling. Anti-inflammatory medication (if tolerated) may help in pain reduction.. However, it is best to avoid anti-inflammatory drugs during the initial 48 to 72 hours when they may encourage additional bleeding. Most people can tolerate paracetamol as a pain reducing medication.

Phase 2: Regain Full Range of Motion

If you protect your injured Achilles tendon appropriately the torn tendon fibre will successfully reattach. Mature scar formation takes at least six weeks. During this time period you should be aiming to optimally remould your scar tissue to prevent a poorly formed scar that will re-tear in the future.

In this stage of treatment a program of a specific program of strtches and strengthening exercise will be prescribed to gently rebuild the injured area. It is important to lengthen and orientate your healing scar tissue via EWST Shockwavetherapy, muscle stretches, neurodynamic mobilisations and eccentric exercises

Phase 3: Restore Eccentric Muscle Strength

Calf muscles work in two directions. They push you up (concentric) and control you down (eccentric). Most Achilles injuries occur during the controlled lengthening (eccentric) phase. Your Podiatrist will guide you on an eccentric calf strengthening programme when your injury healing allows.

Phase 4: Restore Concentric Muscle Strength

Calf strength and power should be gradually progressed from non-weight bear to partial and then full weight bear and resistance loaded exercises. You may also require strengthening for your other leg, gluteal and lower core muscles depending on your assessment findings

Phase 5: Normalise Foot Biomechanics

Achilles tendon injuries can occur from poor foot biomechanics eg flat foot. In order to prevent a recurrence, your foot will be assessed. In some instances, you may require a foot orthotic (shoe insert)

Phase 6: Restore High Speed, Power, Proprioception & Agility

Most Achilles tendon injuries occur during high-speed activities, which place enormous forces on your body (contractile and non-contractile). In order to prevent a recurrence as you return to your sport, your Podiatrist will guide you with exercises to address these important components of rehabilitation to both prevent a recurrence and improve your sporting performance.

Depending on what your sport or lifestyle entails, a speed, agility, proprioception and power programme will be customised to prepares you for light sport-specific training.

Phase 7: Return to Sport

Depending on the demands of your chosen sport, you will require specific sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.

Your Podiatrist will discuss your goals, time frames and training schedules with you to optimise you for a complete return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a through rehabilitation programme has minimised your chance of future injury.

What Results Should You Expect?

There is no specific time frame for when to progress from each stage to the next. Your Achilles tendonitis rehabilitation status will be determined by many factors during clinical assessment.

It is also important to note that each progression must be carefully monitored as attempting to progress too soon to the next level can lead to re-injury and frustration.

The severity of your tendon injury, your compliance with treatment and the workload that you need to return to will ultimately determine how long your injury takes to successfully rehabilitate.

Can Your Achilles Tendon Rupture?

The worst case scenario is a total rupture of your Achilles tendon. Treatment in this case usually requires surgery, plaster or a walking boot for at least six weeks. Most of these injuries take six months or more to adequately rehabilitate.

The best advice is to seek early advice from your physiotherapist to do all you can to avoid this nasty rupture happening in the first place.

Treatment in this case usually requires surgery, plaster or a walking boot for at least six weeks. Most of these injuries take six months or more to adequately rehabilitate.

The best advice is to seek early advice from your physiotherapist to do all you can to avoid this nasty rupture happening in the first place.

Book an Assessment Today

We will contact you within one business day.