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  • Writer's pictureMy Family Podiatry

Understanding Achilles Tendinopathy

Updated: Oct 2, 2023

The Achilles tendon, the human body's thickest tendon, is a key component in many of our routine activities. Serving as a bridge between the calf muscle and the heel, this tendon bears forces that often exceed multiple times our body weight, especially during walking, running, and other forms of physical exertion. Because of its constant engagement, it can undergo degeneration, leading to a condition known as Achilles tendinopathy. Whether it's mild discomfort or severe pain that could escalate to a rupture, Achilles tendon injuries are frequently encountered at My Family Podiatry.

Identifying An Achilles’ Tendon Injury

There are grades of Achilles tendinopathy, the higher the grade, the more the Achilles tendon is damaged and typically the more pain the individual is experiencing. This can range from minor damage, an occasional niggle in the back of the ankle all the way to a complete rupture of the tendon. When individuals visit our clinic, they often report pain and stiffness in the back of the heel and ankle. Often the pain will present immediately upon commencing activity, may warm up and improve a little before becoming worse if the activity level becomes more intense. Achilles tendon pain will often be severe the day following a large amount of physical activity.

One of the primary triggers for Achilles tendinopathy is an abrupt increase in activity levels. This can include a return to sport after off-season, a sudden increase in physical demands at work (longer periods of time standing or more walking) or taking up a new activity such as long walks or jogging without any prior conditioning.

Cartoon diagram showing an inflamed Achilles tendon

How Are Achilles Injuries Treated?

The Achilles tendon, despite its significance, has a relatively poor blood supply. This results in prolonged healing times compared to other soft tissue injuries. Various treatment modalities can be employed to accelerate healing, dependent on the severity and nature of the injury:

Activity Modification: An initial and crucial step in healing Achilles tendinopathy is to stop the aggravating activity. For instance, if running intensifies the pain, consider low-impact alternatives such as elliptical machines or cycling.

Eccentric Loading Exercises: This tendon consists primarily of collagen fibres, which can get disrupted during tendinopathy. Eccentric loading exercises guide the body in aligning these fibres by exerting the right kind of forces on the tendon. The essence of this exercise involves a calf raise with an isometric hold at the peak, followed by a gradual descent back to the starting position. This lengthening of the muscle under tension — eccentric loading — promotes forces that encourage healing.

Shockwave Therapy: Extracorporeal shockwave therapy (ESWT) can be an effective treatment for Achilles tendinopathy. This non-invasive procedure delivers shockwaves to the affected area, enhancing blood flow to the area, and accelerating the healing process. ESWT can alleviate pain and foster tendon regeneration. It's particularly beneficial for chronic cases that haven't responded well to conventional treatments.

Avoid Stretching: At My Family Podiatry, we recommend against stretching for Achilles tendon injuries. Instead of adding stress to the tendon through stretching, it's preferable to alleviate calf muscle tension via massage techniques. Utilise tools like foam rollers or even a rolling pin to ease the calf muscles. Additionally, dry needling can help in diminishing tension in the calves and lower leg muscles.

Orthotics: Your foot's posture and mechanics during standing, walking, and running can significantly influence the stresses on the Achilles tendon. Orthotic devices can modify these forces, reducing the load placed on the tendon, which in turn can reduce pain and facilitate the healing process.

Tips To Avoid Achilles’ Tendinopathy

Increase Exercise Gradually: Rapid increases in exercise is one of the main contributors to Achilles’ tendinopathy. If you're planning to get back into running or start a new regimen, it's crucial to progress gradually. If you aspire to run 5km/day, initiate with 1km and gradually increase over several weeks.This ensures the increased load each week is not excessive and the body is capable of absorbing the force without issues arising.

Routine Stretching And Calf Massage: Regularly stretching and massaging the calves can prevent them from becoming overly tight, which might limit the ankle's mobility and add undue stress to the Achilles tendon. Ideally, hold stretches for around 45 seconds to allow muscles to relax.

Change Footwear Gradually: Moving from high heels all week to barefoot and thongs all weekend places very different loads into the Achilles’ tendon. If you are in a role which requires wearing high heels, ensure you are stretching and massaging your calves regularly to ensure these do not become problematic.

If Achilles issues have been a persistent bother, or if you're finding it challenging to resume regular physical activities, the experts at My Family Podiatry are here to help. Give the team a call on 07 3088 6116 or book an appointment through the button below.

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