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Achilles Tendonitis

Achilles tendonitis, also referred to as Achilles tendinopathy, is an injury to the thin tendon that attaches the calf muscles to the heel at the back of the ankle.

What is Achilles Tendonitis?

Achilles tendonitis, also referred to as Achilles tendinopathy, is an injury to the thin tendon that attaches the calf muscles to the heel at the back of the ankle.

it is a common injury caused by overuse of the muscle on the painful tendon. It is most commonly seen in runners who have a sudden increase in training intensity, duration or gradient without adequate build-up in training.

It is also frequently seen in middle-aged athletes who play sports for recreation such as tennis or football (soccer) at the weekends once a week.

 

The role of the tendon.

All tendons attach muscle to bone. The role of the tendon is to transfer the force generated by the muscle to produce movement at a joint. In this case, when the calf contracts it pulls the heel up and pushes the foot down.

Tendons are designed to be strong and rubbery, with a small amount of elasticity to them.

Tendons will naturally thicken over time to deal with an increase in forces generated by the muscles. If this is done gradually in combination with a strength training routine it acts for the benefit of the person. However, Achilles tendonitis happens when the increase is sudden, the tendon reacts to the increasing demand and becomes painful and stiff.

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How to test for Achilles Tendonitis 

At Riixo we always recommend speaking to a medical professional to better understand a condition and to fully diagnose but this test can help identify if you have Achilles tendonitis.

If the onset was sudden and sharp, if you experience persistent pain or the disability is severe, please seek medical advice for an investigation into an Achilles rupture.

Palpate

  1. Sitting on a chair with both feet on the floor.
  2. Cross your legs by lifting your painful foot and putting it over your other knee.
  3. With your finger and thumb gently palpate the Achilles tendon, starting at the heel and moving up.
  4. You are feeling for any thickening of the tendon or areas that are particularly tender.
  5. If you find an area that is thicker keep your finger and thumb on the area.
  6. Flex and extend your ankle by pointing your toes and bringing them back up.

If the thick area or lump moves with the movement of the foot then it is likely you have Achilles tendonitis (tendinopathy).

Heel raises.

Depending on your level of irritability this can be done with both feet on the ground or one at a time.

  1. Stand on a step with your heels and mid-foot over the edge, and make sure you have something to hold on to.
  2. Lower the heel down then raise up to your tip toes.
  3. Repeat this for 30 seconds trying to maintain a constant speed and count how many you do.

For double leg, you are seeing how each side compares and if the symptoms are triggered in the painful foot.

For a single leg, you are comparing how many you do left vs right, as well as seeing if the movement triggers your symptoms.

What are the symptoms of Achilles Tendonitis?

Achilles tendonitis pain commonly builds up gradually over a period of time. It will most likely start as a mild ache at the base of the calf or just above the heel and over time it will start to get worse. Typically, Achilles tendonitis will feel stiff and sore first thing in the morning, it often eases with mild exercise then becomes stiff and tender with periods of rest.

If the reason for the pain is not addressed it will continue to intensify and tasks such as climbing stairs or walking up an included gradient will be particularly painful. This is more evident when doing endurance sports such as running. The first half of the run will be relatively pain-free but you will start to notice an increase in pain towards the end of the run as the body becomes fatigued.

What are the main causes of Achilles Tendonitis?

There are two primary classifications of causes of Achilles pain in runners

  • Your biomechanics (Intrinsic factors)
  • Your environment (Extrinsic factors)

Intrinsic factors: 

  • Foot biomechanics. Flat feet (overpronation) are one of the most common contributing factors to Achilles tendonitis. Overpronation causes the foot to roll inwards towards the big toe flattening out, in doing so it puts additional force and stress through the Achilles tendon.
  • Biomechanical abnormalities, such as leg length discrepancy, ankle restrictions or reduced range of movement alter the weight distribution and transfer of force through the Achilles tendon. This additional workload will cause irritation to the tendon.
  • Strength imbalance. This normally occurs after an injury or a long period of rest where you will experience some deconditioning, for example, in the calf muscles. This imbalance means that one side will fatigue quicker increasing the load through the Achilles tendon. This can occur on the fatigued side or on the side that is stronger as it will need to work harder to compensate.
  • Biology. Biological factors such as age contribute to Achilles tendonitis as we naturally lose some of the elastic properties in our soft tissues.

Extrinsic factors:  

  • Training increases. A sudden increase in training intensity, duration or gradient without adequate build-up is one of the primary causes of athlete Achilles tendonitis. This is because the body, specifically the Achilles tendon, has to react quickly to the rapid increase in demand causing it to become stiff and painful.
  • Incorrect or old footwear. Footwear that provides an inadequate level of support for your foot mechanics will contribute to Achilles tendonitis.

 

How can I prevent Achilles Tendonitis?

  • Increase your activity level gradually. A common contributing factor to Achilles tendonitis is a sudden increase in training intensity or duration without adequate build-up in training.
  • Take it easy and don’t try to ‘push through the pain’ as this will only make it worse. Ensure that you are adequately warmed up ahead of any high-intensity exercises.
  • Choose the right shoes for your running style. It is worth investing in the correct footwear and, if possible, having your gait analysed. This will provide the correct level of arch support for the foot and minimise the loading through the Achilles tendon. You should also replace your footwear every 250-300 miles (4-6months).
  • Strengthen your calf muscles. Strong calf muscles assist the Achilles tendon in handling the stress that is placed through it.
  • Cross-training through other sports disciplines will also minimise the risk for Achilles tendonitis by improving your cardiovascular fitness and strength whilst altering the loading through the Achilles tendon. This allows it time to rest and become stronger at the same time.

 

How to treat Achilles Tendonitis

  • Change your training routine. You need to let the Achilles tendon and calf muscles rest and recover but total rest can be detrimental. If you are a runner things like swimming, gym-based exercise or light cycling can help maintain your fitness and strength whilst reducing the load placed on the Achilles tendon.
  • Heel raises or insoles placed inside the shoe can offload the tendon. By raising the heel by around 1cm you reduce the amount of stretch placed on the tendon. Once the pain in the Achilles tendon starts to reduce then you can begin to reduce or remove the heel raise from your footwear.
  • Heat is most beneficial for chronic conditions such as Achilles tendonitis as it helps stimulate blood flow to the area and improve the tissue elasticity. The Achilles tendon has a poor blood supply and is part of the reason why injuries can take time to recover so applying heat can assist with tissue repair. Apply heat direct to the area for 20 minutes every 4-6 hours. Applying heat to the area prior to any strenuous exercise will also help prepare the muscles and the Achilles tendon.
  • Ice can help to reduce pain and inflammation to the area. This is best used immediately after exercise or bouts of strenuous activity to help reduce the pain in the area. Apply ice directly to the area for 20 minutes to help manage your symptoms.
  • Over the counter medications such as non-steroidal anti-inflammatories and pain killers can help manage the symptoms of Achilles Tendonitis. For advice on these please speak to your doctor or pharmacist.

 

Exercises for Achilles Tendonitis.

Implementing a structured strengthening program can help reduce the symptoms of Achilles tendonitis as well as preventing future reoccurrence.

Below are a list of exercises to help start your rehabilitation.

Single-Leg Standing

This exercise helps with neuromuscular control by strengthening the small intrinsic muscles that help with balance, joint stability and movement feedback to the brain.

  • Place a folded towel or pillow on the floor.
  • Stand with one foot on the object.
  • Lift one foot off the ground keeping your hands by your side and a slight bend in the knee.

Frequency and duration 

  • Stand for 30 seconds for each leg
  • Complete this frequently throughout the day or for a more structured approach, 3 sets of 30 seconds on each leg 4 times a day.

Alternatives

  • Easier - Do this on a hard floor
  • Harder - close your eyes

Calf Stretch

  • Stand facing a wall with one foot in front of the other toes pointing forward.
  • Place your hands on the wall and lean forward bending the knee closest to the wall.
  • Keep the heel of the foot behind you pressed into the ground.
  • You should feel the stretch through the Achilles tendon and calf muscle

Frequency and duration

  • Hold for a count of 30 seconds on each leg
  • Complete frequently throughout the day.

Alternatives

  • Harder - complete this exercise on a step allowing your heel to drop lower increasing the stretch.
  • Soleus stretch - Bend the rear knee slightly but keeping your heel on the ground. This will target the deeper muscles in the calves.

 

Plantar Flexion Against Resistance

This exercise is designed to help strengthen the calf muscles as well as improve ankle mobility.

  • Sit on the ground with one foot planted for support and the other slightly out in front.
  • Place a resistance band or towel around the ball of the foot
  • Gripping the band/towel in both hands, push the foot down whilst still keeping the heel in place.
  • Return the foot back to the neutral position in a controlled manner.

Frequency and duration

  • Push down for a count of 2 seconds
  • Hold for a count of 2 seconds
  • Raise back up for a count of 2 seconds
  • Complete 3 sets of 12 on each leg

Alternatives

  • Easier - Apply less resistance
  • Harder - Apply more resistance

 

Isometric calf raises

This exercise is will help to strengthen the calf muscles in a controlled manner using your body weight.

  • Stand with both feet on a step and your heels over the edge.
  • Raise yourself up and then remove one leg so you are standing on one foot.
  • Lower yourself down in a controlled manner until your heel is lower than the step.

Frequency and duration

  • Raise up with both feet
  • Lower for a count of 3 seconds
  • Hold for a count of 1 second
  • Complete 3 sets of 12 on each leg

Lateral Step-ups

This exercise is designed to improve leg strength, balance and neuromuscular control.

  • Stand with one foot on a step and one foot on the ground.
  • Push through the foot on the step to raise yourself up.
  • Drive the trailing leg up till the knee is at 90°.
  • Hold at the top then lower yourself back down.

Frequency and duration

  • Raise for a count of 2 seconds.
  • Hold for 2 seconds.
  • Lower for a count of 2 seconds.
  • 3x sets of 12 on each leg.

Alternatives

  • Easier - side step up entirely placing both feet onto the step.
  • Harder - hold weights in your hands

 

The information on this site is intended for educational purposes.

You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider. If you have any specific questions about any medical matter you should consult your doctor or other professional healthcare provider. If you think you may be suffering from any medical condition you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.

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