Understanding Achilles Tendon Pain
The Achilles tendon is the strongest in the human body, able to withstand over 12 times your body weight when it is in good health. Achilles Tendinopathy is a common overuse condition which results in a lack of flexibility and pain.
There are two main types of Achilles tendon pain, Insertional and Mid-portion. The difference between the two kinds refers to the location of the condition. Insertional Achilles tendinopathy originates where the tendon inserts into the heel bone. Mid-portion tendinopathy occurs in the main body of the cord in between the heel bone in the calf muscle.
Achilles tendinopathy has previously called Achilles Tendinitis. The language change is mostly because surgical specimens do not show much inflammation. The suffix "-itis" infers that inflammation is present; however, surgical specimens reveal a breakdown and degeneration in the tendon fibres without significant inflammation. This breakdown in the tendon fibres results in the increase in stiffness and pain that my patients often report.
Pain is commonly in the morning and after rest, typically making the first few steps difficult. The the pain is behind the ankle in the region of the Achilles tendon. It is also common to feel some swelling, particularly in mid-portion Achilles Tendinopathy. In the clinic, You will typically notice some muscle weakness in the affected leg, and sometimes there can be stiffness or excessive flexibility at the ankle joint, both can result in undue stress on the tendon.
In some cases, Achilles tendinopathy may not be the cause of your pain. Urgent evaluation is needed if your symptoms include:
- Pain during the night
- Swelling or redness around the heel or leg
- An inability to support weight on your foot
- Morning pain that does not decrease during the day
Patients describe pain behind the ankle in the morning and after rest, typically making the first few steps difficult. It is also common to feel some swelling, particularly in mid-portion Achilles Tendinopathy. In the clinic, You will typically notice some muscle weakness in the affected leg, and sometimes there can be stiffness or excessive flexibility at the ankle joint, both can result in undue stress on the tendon.
How is Achilles tendinopathy diagnosed?
A simple test which you can do at home is to count how many single-leg heel raises you can perform on each leg. If you are suffering from Achilles tendinopathy, you will typically start to feel pain in the Achilles tendon, and it is unlikely you will be able to achieve the same number of heel raises as compared to the unaffected leg.
X-rays and scans are not always necessary, but it can often be useful to grade or understand the severity and also to exclude other possible conditions.
Ultrasound scan provides clear information on the tendon's health and also allows visualisation of the degenerative changes. Ultrasound is a non-invasive scan which is performed by a sonographer. An ultrasound scan enables the Podiatrist to assess the Achilles tendon, heel bone, and other relevant structures. Thickening of the Achilles tendon connection point, along with micro-tearing, is a typical sign seen through ultrasound which can confirm the diagnosis of Achilles Tendinopathy.
Risk factors for Achilles tendinopathy?
Achilles tendinopathy typically develops between the ages of 35 and 75. As we age, our tendons and ligaments become less flexible and capable.
Carrying a few extra kilos puts additional stress on the body's joints, ligaments, and tendons. Having additional weight also impacts hormone balance, which can, in turn, reduce the body's ability to heal overuse injuries such as plantar fasciitis.
A sudden increased activity
When physical activity increases faster than the body's ability to adapt or recover, this overload on the body's tendons and ligaments can lead to overuse injuries which is often the case in heel pain.
It should be no surprise that inadequate sleep impairs the body's ability to repair and regenerate. A good night's sleep is essential to allow your body to repair cellular damage caused during the day. If you are having trouble sleeping, some simple adjustments you can make include:
- Reducing caffeine intake
- Dimming the lights in your house 1-2 hours before bed
- Avoiding any screen time for 2 hours before bed
Shoes that are too flexible or flat increase strain on the Achilles tendon during walking and running. Your shoes must have a firm, supportive heel and some stiffness through the midsole. If you can bend your shoe in half, as a general rule the shoe is not providing adequate support to the foot arch. A right, supportive shoe should have a firm heel to provide optimal support to the heel and ankle. In general, the worst type of shoes for Achilles tendinopathy is very flexible and very flat.
Genetics – Foot type
Too much stiffness or flexibility of the feet and ankles increases the strain on the Achilles tendon and contribute to Achilles tendinopathy. This is often the case in 'flat feet' or 'fallen arches', but also in those with high arches.
If you don't use it, you lose it. A sedentary lifestyle or work environment can increase your risk of developing plantar fasciitis. Inactivity can reduce the load capacity of the tendons and ligaments, increasing their risk of injury.
What to do if you have started experiencing Achilles tendon pain?
Rest might be advisable in the acute phase; however, if it has been more than a few weeks, rest is unlikely to help. It is vital to reduce the load on the tendon without necessarily stopping all activity. In people walking and running for exercise, intensity duration and frequency of training should be observed. Achilles Tendinopathy reduces the capacity of the tendon due to degeneration and reduced flexibility. Just like in weight training, tendons and muscles need a certain amount of load for them to adapt, getting more substantial and more robust. However, if the physical demand exceeds the tendons capacity, it will result in damage and loss of function.
Treatments are tailored to the individual; they may include:
- controlled loading & prescribed exercises
- Footwear recommendation
- Strapping and bracing
- Prescribed exercises and stretches
- Swiss DolorClast® (Shockwave Therapy)
- Injection Therapy
Achilles Tendinopathy is best treated sooner rather than later.
Book an appointment to find out how we can help you get back on your feet pain-free!
Mr James Ferrie
B. Pod. (La Trobe); Mem. A. Pod. A
Principal Practitioner / Founder of My Sports Podiatrist