Understanding Achilles Tendinopathy and How A Podiatrist Can Help

Have you had an achilles tendon injury before and would like to know more of what, why and how to treat this common and yet disabling condition?

What is the purpose of the Achilles tendon?

The Achilles tendon is attached to the gastrocnemius and soleus muscle at the back of the lower leg. The Achilles tendon is an energy storage tendon, meaning it can take greater strains and stores this to then release that energy given us the forward thrust just like when we walk and run. When this tendon is pushed too far, tendon injury can occur.

What happens when the achilles tendon is injured?

Achilles tendinopathy is a tendon disorder that has been shown to be degenerative in character rather than a regular inflammatory process, which is related to an ‘overuse injury’ to the tendon.

Insertional achilles tendinopathy is painful on the back of the calcaneus (heel bone) and pain replicates when the foot is moved into dorsiflexion (toes pushed up towards shin).

Mid-portion achilles tendinopathy pain 2-7cm above the heel bone in the thick portion of the tendon. This type is the most common and usually occurs from an unexpected increase in load over what the tendon has adapted to, this can include an increase in frequency, duration or intensity of activity. 

Risk factors for development of achilles tendinopathy

Below are risk factors that may increase the chances of developing achilles tendinopathy:

• Previous lower limb tendinopathy
• Recent injury
• Advancing age
• Sudden Increase in activity level
• Not enough recovery time between activity/training.
• Long periods of inactivity, for example return from holidays, injury, sedentary lifestyle.
• Sudden change in terrain
• Footwear
• Reduced ankle flexibility
• Weight
• Poor foot mechanics

What may you experience if you have achilles tendinopathy 

• Pain is usually felt at the back of the heel and/or on the tendon.
• Pain after exercise or the following day, particularly the morning.
• Pain free at rest which intensifies with activity.
• Regularly pain becomes better after being warmed up, only to return when they cool down.
• Maybe local tenderness and/or thickening

Stages of achilles tendinopathy

It is important for the podiatrist to recognise which phase your tendon is in as this will dictate treatment. This is gained in the initial consultation with a thorough history and also during the assessment.

Reactive/early-stage tendinopathy – a non-inflammatory phase where the tendon acutely becomes overloaded and may have a thickened appearance, in this case the patient may have a sudden onset of symptoms.               

Tendon dysrepair – describes a decline in the tendon pathology, in this stage the tendon collagen matrix becomes slightly disorganised with vessels and nerves. This is often seen in chronically overloaded tendons.

Degenerative tendinopathy – in this stage large areas of collagen are chaotic and filled with vascular and nerve cells, the collagen fibers are disorganised. The tendon may have focal nodular areas with or without general thickening. Characteristically seen in patients with long term tendon overloading. This tendon is at high risk for rupture.       

How is achilles tendinopathy managed?

As podiatrists we play an important role in getting you back to your goals whatever that may be. I will outline the common interventions used in achilles management below.

• It will be advised to reduce or cease activity that is the cause
• Heel lifts are given in the initial consultation along with some taping to reduce pain
• Alter training so that recovery days are increased between activities.
• Prescribing a personalised stretching and strengthening program
• Address identified risk factors.
• Shockwave therapy may be beneficial 
• Dry needling of the gastrocnemius/soleus muscles.
• Orthotics.
• Massage to the calf muscles.

If you think you have achilles tendinopathy and would like an assessment, we’d be more than happy to help.  You can book an appointment online or call our help team on (03) 9711 7562 if you have any questions.  We’re here to help.