What is Achilles Tendon Pain?
Achilles tendinopathy is pain affecting the Achilles tendon when it can’t tolerate a certain load being put through it. The condition can vary in severity from a mild pain in the tendon during a minor activity to more severe cases, where any form of physical activity that places strain on the structure, even standing or walking, can cause intense pain.
Signs and Symptoms of Achilles Tendon Pain
Symptoms usually include pain in the Achilles tendon, which is often worse after rest or with excessive activity. There can be local swelling when in an acute phase and thickening when in a chronic phase. It commonly occurs 2-3cm above the heel bone, but may also occur at the insertion of the Achilles tendon into the heel bone.
Causes of Achilles Tendon Pain
Achilles tendinopathy most commonly results from overuse, where the tendon is continuously stressed until small tears occur. Sudden increases in physical activity is also a common cause, due to the tendon not being conditioned to withstand the increase physical stress.
Other causative factors may include:
- excessive pronation or flattening of the feet,
- tight or weak calf muscles,
- reduced ankle range of motion,
- inappropriate or old footwear,
- unbalanced muscle groups,
- excessive sand or hill running,
- poor biomechanics (the way you walk)
Conservative Treatment
Because Achilles tendinopathy can quickly progress and reduce your ability to engage in activity, we recommend treatment as soon as possible. This will also reduce the chance of further complications.
It is recommended that a Biomechanical Assessment be performed to get a detailed understanding of the condition specific to you. Once Biomechanical Assessment is complete, a tailored treatment plan will be developed. The type of treatment depends on the site of the pain, the duration of symptoms, foot function, footwear, and your current or intended activity levels.
The aim of the treatment is to reduce strain on the tendon, reduce inflammation and strengthen the tendon so it can tolerate more load.
- Activity modification. An initial change to your exercise regime or daily activities may be needed to avoid the condition getting worse. The introduction of a low impact alternate activity may also be of benefit such as swimming.
- Strengthening/Isometric loading. It is important that calf strength is addressed for achilles pain so the tendon can tolerate more load. This is done initially with isometric loading to load up the tendon in a pain free way.
- Increase in ankle range. Poor ankle range can be a common mechanism contributing to achilles pain, therefore intervention to increase ankle ROM will be implemented when necessary.
- Heat or Ice. This condition may respond better to either heat or ice depending if there is an acute flare up or chronic management.
- Anti-inflammatory. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, naproxen, or aspirin, will help with pain and swelling as per GP instructions.
- Adequate footwear. Supportive and appropriate footwear is recommended to stabilise the foot and ankle. Avoid wearing thongs, slippers, sandals and barefoot.
- Taping/Bracing. Taping or bracing can help to stabilise the foot and ankle and reduce excessive stress on the achilles.
- Orthotic therapy: A custom orthotic device placed in the shoe can help address possible causative factors such as flat feet, to reduce stress on the achilles.
- Extra Corporeal Shockwave Therapy. A non-invasive treatment where shockwaves are sent into the foot to stimulate the body’s own healing process.
Surgery for Achilles Tendon Pain
In cases that are non-responsive to conservative treatment, surgical intervention may be required. For some advanced cases, surgery may be the only option.
