Achilles Tendinitis Prevention & Treatment [Updated 2022]
Anatomy of the Achilles Tendon
The Achilles tendon is one of the largest and strongest tendons in the human body, and can tolerate loads greater than our own body weight.
In this article I will discuss:
- Why do Achilles Tendons get injured?
- The Types of Achilles Tendinitis (Tendinopathy),
- The Multi-Factorial Nature of Achilles Injuries,
- How Can I Prevent Achilles Injuries?,
- How Should I Treat My Achilles Injury?,
- Who Can Help Me?
The Achilles tendon is a continuation of two muscles known as the ‘Calf’ muscle which is comprised of the Gastrocnemius and Soleus.
The Achilles tendon continues down the back of the leg and attaches onto the back of the calcaneus (heel bone).
To learn more about heel pain check out our heel pain blog article here.
The achilles tendon is constantly under tension regardless of what you are doing. Injuries to the achilles tendon can occur in the ‘mid-portion’ or ‘insertion’.
During exercise the achilles tendon (along with the calf muscles) have an ability to stretch an absorb load, that load then utilised in a ‘spring like’ action to aid in propulsion.
This is one of the ways the body can achieve ultimate energy efficiency.
Why do Achilles Tendons Get Injured?
For the majority of the time, achilles pain occurs because it has been overloaded causing tendinopathies, however partial and full ruptures of the achilles tendon can occur.
This comes about through placing excessive load through the tendon over a long period of time.
The tissue can tolerate excessive load in small spurts, but when it is constantly being overworked, the tissue reaches a ‘threshold’ whereby is cannot keep up, and it breaks down.
The symptoms of this type of injury are evident from very early on – you just have to be listening to your body.
The Types of Achilles Tendinitis (Tendinopathy).
The Achilles Tendon is very susceptible to overuse because it is constantly absorbing high tensile stress (strong pulling force) during running.
This constant force causes micro tears within the tendon which leads to inflammation, swelling, and pain.
Insertional Achilles Tendinitis
At this insertion point there is an anatomical (meant to be there) bursa which cushions the shock between the heel bone and the Achilles tendon.
With insertional tendinitis the bursa gets inflamed as well there will often be redness, swelling and pain at the back of the heel bone.
This can sometimes result in calcification of some fibres which becomes a bone spur growing upwards from the heel bone which is often quite obvious on x-ray.
Non-Insertional Achilles Tendinitis
Non-insertional Achilles Tendinitis is any tendinitis which occurs between the heel bone and where the tendon begins at the calf muscle.
Stress causes tiny tears in the micro-fibres which make up the tendon. These tears cause swelling and calcification leading to a permanent change in the tendon which is often a palpable and visible lump.
Although these changes are permanent, the pain and lack of function need not be, and with good rehabilitation the tendon can become even stronger than before.
The Multi-Factorial Nature of Achilles Injuries
The cause of achilles tendinopathies are multifactorial, meaning there is often more than one causative factor. Here are just a few:
- Poor strength within the entire lower limb
Poor flexibility and range of motion
- Inappropriate or worn out footwear
- Training errors – most common error is over training
- Inefficiencies within your biomechanics
How Can I Prevent Achilles Injuries?
It is important that you are putting as much time and effort into recovery between training sessions for ‘maintenance’ of the body as you do with training.
- Allow rest days between training sessions
- Strength work focusing on back/glutes/Hamstring/calf.
- Stretching to improve flexibility
- Wearing the appropriate footwear and replacing shoes when needed.
- Addressing any biomechanical abnormalities
How Should I Treat My Achilles Injury
Initial treatments, aimed at reducing swelling and bleeding, include:
– RICE protocol (Rest, Ice, Compression, Elevation)
– Offloading achilles tendon with orthotic/footwear modifications (heel raise)
– Activity modification
Further treatments, aimed at restoring tendon function, include: – Isometric Exercises for pain relief – Eccentric exercises for strength – Range of motion exercises – Proprioceptive training
An illustration showing the anatomy of the Achilles tendon. The tendon is highlighted in red and the rest of the anatomy is blue.
An important concept to consider is one put forward by Jill cook entitled ‘The continuum model for tendon pathology.’
It outlines how the tendon needs to be under an ideal load to repair effectively.
Early return to activity, and complete offloading are therefore harmful in the recovery of tendon injuries.
If there is ongoing issues despite these initial treatments, you may require custom foot orthotics (insoles made just for your feet from 3D laser scans. See more here)
These are a great conservative treatment that allow us to control the movement of force through the foot and leg.
This allows us to decrease the stress that is placed on the soft tissue surrounding the tender areas, which gives the body a chance to heal.
Other conditions that produce similar symptoms to Achilles Tendinitis include: retrocalcaneal bursitis and posterior impingement syndrome.
Who Can Help Me?
As Podiatrists, we identify the cause of the injury and understand what is driving the injury.
By identifying the causative factors, we can then tailor a management plan around you to get you back being active.