Achilles Tendinopathy
I see a number of clients coming into clinic with posterior ankle pain. There can be a number of different causes to this posterior ankle pain, including ankle bursitis, fat pad inflammation, and plantar fasciitis to name a few.
That’s where differential diagnosis is very important. Usually an Achilles Tendinopathy will present with:
Sharp pain on palpation of the Achilles, usually this is very localised to one specific area of the achilles - either insertional (where the achilles attaches the heel bone) or mid portion (part way up the achilles tendon).
Stiffness of the ankle in the morning, finding that the first few steps can be quite painful in the Achilles tendon, which usually subsides are a few minutes of walking about.
When starting any form of exercise that involves the lower limb (running, walking, high impact sports) it will initially be quite sore/painful, which usually subsides after the first 5-10 minutes, once the Achilles has warmed up properly.
You may also experience pain/soreness on the initial movement of standing up and walking if the ankle has been immobile for long periods (sitting at your desk working/watching tv in the evening).
Tight calf muscles usually accompany an achilles tendinopathy.
What causes a Tendinopathy?
Tendinopathy occurs from continuous overload of the tendon. There are three stages of tendinopathy – reactive tendinopathy, tendon disrepair and degenerative tendinopathy. In the later stages you are more likely to experience a change in the tendon thickness, which is usually very painful to touch.
This injury is very common amongst long distance runners, especially when increasing the intensity, frequency or type of activity, for example marathon training.
That said, you don’t have to be an elite athlete to have achilles tendinopathy, it may just be that you’ve increased the amount of walking performed each day. If your routine has recently changed and you’ve decided to increase your activity levels, or even the terrain you’re used to exercising on, it may lead to achilles tendinopathy issues.
5 tips to improve Achilles Tendinopathy:
Stretch out the calf muscles, holding for 20 seconds. Repeat 3 times.
Ice the achilles for up to 15 minutes at a time, at the site of pain.
Perform eccentric heel drops on the problematic ankle 10-12 reps (2 sets).
Foam roll the calf muscles 2-3 times a week to reduce tightness.
Reduce the amount of activity you are doing for 1-2 weeks if your training is predominately lower body focused. It is important to note, we want to modify activity rather than stop it all together, too much rest is bad for the tendon, as tendons need to load to maintain its structure.
It is important to get a full assessment on the lower limb to determine correct diagnosis and rehabilitation advice, as there are many structures close to the achilles tendon, which may be causing the pain.
Another factor to consider is which aspect of the achilles is painful, as you may have either a mid-portion or insertional achilles tendinopathy, which affects the treatment given. It is best to be diagnosed in the first stage of tendinopathy, as recovery time is a lot faster compared to someone in the last stage. Therefore, do not wait for the pain to go away by itself, get it assessed and treated straight away to allow you to get back moving and training pain free.
We see a lot of Achilles Tendinopathies in the clinic, so if this sounds familiar get booked in for an injury assessment so we can diagnose you early and get you back to fitness 💪🏼