Achilles Tendinitis:

What You Must Know

Have you noticed a pain at the back of your leg especially in the morning or after a long walk or gym activities or even sitting for long periods? That thick tendon we call the Achilles tendon. It connects the calf and soleus muscle to insert into the heel bone. It’s the strongest tendon in the body and allows you to push off while walking, running, and jumping.

So, why would the strongest tendon in your body start to hurt especially after you have done your google searches and you have done the recommended calf stretches and eccentric loading exercises and off course the famous glute exercises and tried the 6 shockwave sessions which every health medical clinic owner swears by.

Most health professionals point fingers to the surrounding muscles around the ankle to say it’s weak and too much load is going through the strongest tendon in the body. So, they tell you to do eccentric loading exercises for the Achilles Tendon, which has been researched very well and does make sense. But let’s take a step back and asked the question why the strongest tendon in the body is weak and why is it sore?

Pain is not always driven by weakness, what about alignment further up the chain like the head, pelvis and the alignment of your ankle bones even still the alignment of your big toe pushing of the floor when you walk or run.

If you have lost the ability to lift your big toe off the floor that’s placing your whole ankle biomechanics at risk and this is a big player for foot and whole-body mechanics. So losing this ability to perform such a significant movement what impact does this have on your Achilles tendon? These are the questions to ask your health professional and it’s not because you have weak glutes and weak calf muscles. Look at the Active windlass mechanism how it works.

We as health professionals and patients need to stop looking at the symptoms but try and understand why it has occurred and what is the driving factor. But this does not mean you ignore your symptoms. Long term health and wellbeing is the goal you want to achieve whilst also finding out why this pain is always an issue for your body and why does it keep recurring. Obviously if you have had a major trauma which has just occurred like a car accident or impact from sporting activity you would give this some attention first.

There are 206 bones in the body and 25% of those bones are in your foot what if one of the bones in the foot is stuck or restricted for example the talus bones and the tibia what impact will that have on your Achilles pain?? Refer to my service page or read on to find out about Achilles Tendinitis.

Achilles Tendinitis

Achilles tendinitis is a common condition that occurs when the large tendon that runs down the back of the lower leg becomes irritated and inflamed.
The Achilles tendon is the largest tendon in the body. It connects the calf muscles to the heel bone and is used when you walk, run, climb stairs, jump, and stand on your tip toes. Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendinitis, a condition associated with overuse in my opinion poor biomechanics which could be form previous injury and compensatory issues through the body.

Common symptoms of Achilles tendinitis include:

• Pain and stiffness along the Achilles tendon in the morning ort after activity.
• Pain along the tendon or back of the heel that worsens with activity and becomes stiff.
• Severe pain the day after exercising.
• Thickening of the tendon.
• Bone spur formation (insertional tendinitis)

Two areas where Achilles pain can be located.

Non insertional Achilles tendinitis and Insertional Achilles tendinitis

In non-insertional Achilles Tendinitis, fibres in the middle portion of the tendon (above where it attaches to the heel) are affected. Over time, the fibres may begin to break down and develop tiny tears. This can lead to tendon swelling and thickening.

Insertional Achilles Tendinitis involves the lower portion of the tendon, where it attaches (inserts) to the heel bone (also known as the calcaneus).

In both non-insertional and Insertional Achilles Tendinitis, damaged tendon fibres may calcify (harden) over time. Bone spurs often form on the heel with insertional Achilles tendinitis.

Insertional Achilles Tendinitis can occur at any time or activity level, although it is still most common in runners. It is frequently caused by calf muscle tightness, which places increased stress on the Achilles Tendon Insertion.

Cause

Achilles tendinitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. As explain before it could be ankle bones not able to move from the position they are in or poor alignment structural changes directly to the foot like the big toe or past injuries affecting the way you use your achilles.

• A sudden increase in the amount or intensity of exercise activity. For example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance may cause irritation and inflammation.
• Tight calf muscles due to the ankle bones unable to move tightness puts extra stress on the Achilles tendon, especially where it inserts into the heel bone.
• Haglund’s deformity. This is a condition in which there is enlargement of the bone on the back of the heel. This can rub on the Achilles tendon and cause inflammation and pain. This is caused by poor biomechanics where ankle function has been limited for a while.

Health Professional Examination

After you describe your symptoms and discuss your concerns, the doctor will examine your foot and ankle. The doctor will look for these signs:

• Swelling along the Achilles tendon or at the back of your heel.
• Bone spurs or pain near the lower part of the tendon at the back of your heel (Insertional Tendinitis).
• Pain in the middle of the tendon, (non-insertional tendinitis)
• Heel pain when stretching your calf.
• Limited range of motion in your ankle — specifically, a decreased ability to point your toes downward.

In my opinion and experience getting the right exercises routine, physiotherapy and eating well using natural anti-inflammatory food is a much better solution, refer to my web page for more information on this.

Active Rest is what I usually would tell my patients

The first step in reducing pain is to decrease or even stop the activities that make the pain worse. If you regularly participate in high-impact exercises (such as running), switching to low-impact activities will decrease the amount of stress on the Achilles tendon. Cross-training activities such as biking, elliptical exercise, and swimming are low-impact options to help you stay active. The key with active rest is that you want to be less aware of your achilles pain in the morning, after noon and during and after exercises. The better your management of this process the quicker your recovery.

Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Anti-inflammatory drugs such as ibuprofen and naproxen reduce pain and swelling. They can help decrease your pain enough to allow you to perform physical therapy exercises as discussed below. They do not, however, reduce the thickening of the degenerated tendon. Using the medication for more than 1 month should be reviewed with your primary care doctor. In my opinion and experiences getting the right exercises routine and physiotherapy rehabilitation exercise and eating well using natural anti -inflammatory food is better refer to my web page for more information on this.

Tests

Your health professional may order imaging tests to help determine if your symptoms are caused by Achilles tendon. These tests can also help ascertain the severity of your Achilles tendinitis.

Magnetic Resonance Imaging (MRI)

Although magnetic resonance imaging (MRI) is not necessary to diagnose Achilles tendinitis, it is important for planning surgery if nonsurgical treatment is not effective. An MRI scan can show the severity of the damage in the tendon. If surgery is needed, your doctor will select the procedure based on the amount of tendon damage.

Ultrasound

Ultrasound has grown in popularity among physicians in recent years. It is quicker and less expensive than MRI and may be readily performed in an office setting. However, ultrasound is more operator-dependent than MRI and may yield less consistent results.

Extracorporeal Shockwave Therapy (ESWT)

This therapy uses either low- or high-energy shockwaves applied to the Achilles tendon to promote healing of the damaged tendon tissue.

• High-energy ESWT can be done in one visit but requires local or general anaesthesia.
• Low-energy ESWT consists of 3 to 4 sessions and does not require local anaesthesia.

Surgical Treatment

Surgery for Achilles tendinitis should be considered only if the pain does not improve after 6 months of nonsurgical treatment. The specific type of surgery depends on the location of the tendinitis and the amount of damage to the tendon.

After debridement and repair, most patients are allowed to walk in a removable boot or cast within 2 weeks, although the timeline depends on the amount of damage to the tendon.