Achilles Tendinitis (Tendinopathy)

What is ?

It is estimated that Achilles tendonitis accounts for around 11% of all running injuries. The Achilles tendon is the largest and strongest tendon in the body and is located at the back of the ankle. Achilles Tendonitis is a painful and often debilitating inflammation of the Achilles tendon (heel cord)

It connects the large calf muscles (Gastrocnemius and Soleus) to the heel bone (calcaneus) and provides the power in the push off phase of the gait cycle (walking and running). The Achilles tendon also gives us the ability to rise up on our toes, facilitating the act of walking, and Achilles tendonitis can make walking almost impossible.

Achilles tendonitis is often now being referred to as Achilles tendinopathy. This is because it is no longer thought to be an inflammatory condition. On investigation, the main finding is usually degenerated tissue with a loss of normal fiber structure.

Achilles tendonitis can be either acute, meaning occurring over a period of a few days, following an increase in training, or chronic which occurs over a longer period of time. Often, Achilles tendinitis results from sports that place a lot of stress on your calf muscles and Achilles tendon, such as running or basketball. The condition occurs in approximately 6–18% of runners, and also is more common in athletes, especially in sports that involve jumping (e.g., basketball), and in people who do a lot of walking. Achilles tendinitis also is often associated with a sudden increase in the intensity or frequency of exercise.

In addition to being either chronic or acute, the condition can also be either at the attachment point to the heel or in the mid-portion of the tendon (typically around 4cm above the heel). Healing of the Achilles tendon is often slow, due to its poor blood supply.

Symptoms of Achilles Tendonitis

Acute tendonitis:

Gradual onset of pain over a period of days
Pain at the onset of exercise which fades as the exercise progresses.
Pain eases with rest.
Tenderness on palpation.

Chronic Achilles tendonitis may follow on from acute tendonitis if it goes untreated or is not allow sufficient rest. Chronic Achilles tendonitis is a difficult condition to treat, particularly in older athletes who appear to suffer more often.

Chronic tendonitis:

Gradual onset of pain over a period of weeks, or even months.
Pain with all exercise, which is constant throughout.
Pain in the tendon when walking especially up hill or up stairs.
Pain and stiffness in the Achilles tendon especially in the morning or after rest.
There may be nodules or lumps in the Achilles tendon, particularly 2-4cm above the heel.
Tenderness on palpation.
Swelling or thickening over the Achilles tendon.
There may be redness over the skin.
You can sometimes feel a creaking when you press your fingers into the tendon and move the ankle.

There are three stages of tendon inflammation

Peritenonitis is characterized by localized pain during or following activity. As this condition progresses, pain often develops earlier on during activity, with decreased activity, or while at rest.

Tendinosis is a degenerative condition that usually does not produce symptoms (i.e., is asymptomatic). It may cause swelling or a hard knot of tissue (nodule) on the back of the leg.

Peritenonitis with tendinosis results in pain and swelling with activity. As this condition progresses, partial or complete tendon rupture may occur.

Causes of Achilles Tendonitis

Achilles tendonitis is an overuse injury. Too much too soon is the basic cause of overuse injuries, however other factors can contribute to developing the condition. As people age, tendons, like other tissues in the body, become less flexible, more rigid, and more susceptible to injury. Therefore, middle-age recreational athletes are most susceptible to Achilles tendonitis.

Increase in activity (either distance, speed or hills). Often long distance runners will have symptoms of Achilles tendonitis after increasing their mileage or increasing the amount of hill training they are doing.
Less recovery time between activities.
changes in exercise training schedules
Change of footwear or training surface.
Wear an Achilles Healer - Achilles Tendon Strap
Weak calf muscles.
Decreased range of motion at the ankle joint, usually cause by tight calf muscles.
Running up hills - the Achilles tendon has to stretch more than normal on every stride. This is fine for a while but will mean the tendon will fatigue sooner than normal.
Overpronation or feet which roll in when running can place an increased strain on the Achilles tendon. As the foot rolls in (flattens) the lower leg also rotates inwards which places twisting stresses on the tendon. Wearing high heels constantly shortens the tendon and calf muscles.

When exercising in flat running shoes, the tendon is stretched beyond its normal range which places an 'abnormal' strain on the tendon.

Left untreated, Achilles tendinitis could cause persistent pain or cause your tendon to tear (rupture). If so, you may need surgery to correct the damage.