Achilles Tendinopathy (also known as Achilles tendinitis) is a condition that causes pain in the thick tendon that joins your heel bone to your calf muscles. It is a relatively common soft tissue injury and affects people of all ages, both athletes and non-athletes.
Symptoms can include:
- Tenderness over the Achilles tendon – the area may be very tender to touch. In some people there is a painful lump or swelling in the area
- Stiffness - stiffness in the tendon when you get up in the morning or following a sustained period of rest is common. This usually eases after a few minutes of walking in many cases
- Variable pain – some people only report a mild ache which eases with exercise. Other people can experience very severe pain which will limit their walking. Often pain will be increased when you go up onto your toes.
The causes of Achilles tendinopathy are not completely understood but we know it occurs when a tendon is unable to adapt to the strain being put through it.
Sometimes it starts after an injury or strain to the area and it is commonly caused by overloading the tendon, for example suddenly increasing your activity levels.
You are more at risk of developing Achilles tendinopathy if you have diabetes, tight and weak calf muscles, or stiff ankle joints.
Diagnosis is usually made from the patient’s history and a simple examination without the need for further investigations.
Footwear
Wearing supportive footwear with good shock absorbency is important. Using an insert within the shoe or wearing a shoe with a slight raised heel may also help ease pain.
Pain relief
Painkillers such as paracetamol and ibuprofen or anti-inflammatory gels may be helpful to control the pain and allow you to continue exercising. Discuss this with your GP or pharmacist.
Some people find ice effective in reducing their pain.
Apply an icepack for 15 mins, two to three times a day. Avoid applying ice directly to your skin, instead use a towel or have a fabric layer in between.
Weight loss
You are more at risk of developing Achilles tendinopathy if you are overweight. Reducing your weight can also improve symptoms through reducing the stress on your joints, muscles and tendons.
Sedentary and inactive lifestyles increase the risk of developing pain and can also delay your recovery. Being active for 30 minutes in your day can make a big difference in your overall health and improve your pain.
Exercise
Some discomfort can be expected during your exercise rehabilitation period. Therefore, it is important to follow certain guidelines whilst performing exercises.
When you start the exercises, you may experience increased discomfort, especially if this is a new routine or you are making exercise progressions. The discomfort should settle down relatively quickly.
You can use pain to guide your treatment and response to exercise. Pain should not go beyond what you perceive to be 5 out of 10 (based on a pain scale with 0 being no pain and 10 being the worst imaginable pain).
If you experience pain that is less than 3 to 4 out of 10 then you can safely progress the exercise. However, If you notice pain during or following the exercises that is greater than 5 out of 10, you may need to reduce the number of repetitions or sets.
The key is not to do too much but also not too little.
The programme should be completed most days for at least 12 weeks. Although you may not feel any benefits from this exercise programme to start with it important to persevere.
You would usually expect some changes within the first 3 to 4 weeks after starting an exercise regime.
Further management options
If there is no response to the self-management information above within four weeks please seek further advice from your physiotherapist, as discussed during your appointment.