Understanding Achilles Tendon Pain

Information  •  Sun 8 Nov 2020

When the Achilles tendon is in good health, it can withstand over 12 times your body weight. However, if you experience a lack of flexibility and pain because of tendinopathy (overuse), this condition will make things much more difficult for you to manage during physical activity and cause pain.

There are two main types of Achilles tendon pain, Insertional and Mid-portion. The difference between the two kinds refers to where it occurs: inserts at the heel bone (Insertion) vs in between calf and ankle (Mid-portion).

Achilles tendinopathy has been called Achilles Tendinitis. The language change is because surgical specimens do not show much inflammation, which the suffix "-itis" infers. Instead of showing signs of inflammatory cells in a specimen, there's a breakdown and degeneration in fibres without significant inflammation.

When morning comes, you feel your ankle is in pain that makes it difficult to take the first few steps. This pain typically occurs where the Achilles tendon meets behind your ankle and there are some other signs of discomfort which include swelling along with muscle weakness accompanied by limited flexibility.

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

How is Achilles tendinopathy diagnosed?

A simple test which you can do at home is to count how many heel raises each leg can perform. If one of your legs are suffering from Achilles tendinopathy, it will likely start causing pain in the tendon and make performing equal numbers impossible on both sides.

An Ultrasound scan enables the Podiatrist to assess an Achilles tendon, heel bone, and other relevant structures. A sonographer will provide clear information on the tendon's health and also allow visualization of degenerative changes that may be present in a patient with foot pain or injury.

Risk factors for Achilles tendinopathy?

Age
Achilles tendinopathy typically develops between the ages of 35 and 75. Aging causes a loss in flexibility, which can cause our ligaments to weaken over time.

Weight
The extra weight we carry can cause a number of problems for our bodies, including increased joint pain. It also negatively impacts hormone balance which makes it difficult to heal from injuries when they do occur as well!

A sudden increased activity
Too much of a good thing can be bad for you. This is especially true when it comes to exercise, as overworking your body's tendons and ligaments without allowing the time they need to recover before trying again may cause injuries such as achilles tendon pain.

Sleep

If you're having trouble sleeping, here are a few things to try. First of all, as much as possible avoid blue light an hour before bedtime; the body processes this differently than other colors and we tend not to produce enough melatonin - which helps us sleep better - when exposed to it. Second: turn off your phone or put it on airplane mode for one full hour (if that's too long then at least give yourself 30 minutes) before going to bed so your brain can shift its focus from work/social media accounts onto something less stimulating like reading a book instead.

Footwear
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
Those with flat feet or fallen arches are at risk of Achilles tendinopathy. Also, those who have high arches can be prone to this condition due to the extra strain on their tendon.

Sedentary lifestyle
Inactivity can reduce the load capacity of tendons and ligaments, increasing their risk for injury. Sedentary lifestyles or work environments have been shown to increase your risk of Achilles pain so it is important to take care in maintaining a healthy lifestyle.

What to do if you have started experiencing Achilles tendon pain?

Rest is often recommended for the first few weeks, but if you've been resting more than a month and your symptoms haven't improved much it's unlikely rest will help. You can reduce stress on the tendon without completely stopping activity by trying to find activities that don't make things worse or aren’t too difficult with pain.

Treatments are tailored to the individual; they may include:

• controlled loading & prescribed exercises 
• Footwear recommendation
• Strapping and bracing
• Prescribed exercises and stretches
• Orthotics
• 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!