Achilles Tendinopathy

What is Achilles Tendinopathy?

Achilles Tendinopathy is a common problem that affects the large tendon at the back of your ankle. The Achilles tendon is the strongest tendon in your body it attaches the calf muscles (gastrocnemius and soleus muscles) to the heel bone (calcaneus).

Although the exact cause remains unknown, it is thought to be caused by repeated minor injuries, called micro trauma, to the tendon. The Achilles tendon is more vulnerable to injury due to its poor blood supply and high loads that are placed on it.

What are the symptoms?

Typical symptoms include pain, stiffness and swelling at the back of the heel. In more long standing cases the tendon can appear thickened and lumpy.

Pain is often present first thing in a morning, or when you begin to walk after resting for a period of time. The pain can be variable and it can improve as you keep moving. You may notice it is more painful after lots of weight-bearing activities such as walking or running.

If the tendon has been recently aggravated, it may become red, warm and tender to the touch.

Achilles tendonipathy is diagnosed through a history of signs and symptoms and a physical examination without the need for other investgations suchs as an MRI or ultrasound scan. If there is a suspicion of a tendon rupture imaging investigations may be arranged via a doctor.

Most people improve with conservative treatment. Pain and function can improve after 12 weeks of management, but symptoms can often take up to 6-9 months (occasionally longer) to fully resolve. 

What are the causes?

The causes are not fully understood, but these factors are generally considered to be risk factors:

  • Being overweight
  • Age – does affect people of all ages however increasing age increases the risk
  • Having a history of conditions that affect tendon quality such as diabetes, rheumatoid arthritis and high cholesterol
  • Use of long term steroids or fluoroquinolone antibiotics
  • Lack of flexibility such as stiffness in the ankle joint, tight or weak calf muscles
  • Poor foot position, leg length discrepancy or change in walking pattern are common cause for increasing the load on the Achilles tendon and causing more stress
  • Sudden change in activity levels for example repetitive activity or overuse involving the tendon
  • Training techniques; lack of variety, hard surfaces or too much hill running

What can I do to help myself?

  • Reduce any specific activities that aggravate your symptoms, this may include prolonged walking or running but don’t stop completely so you can maintain your fitness.  This may mean that you need to pace such activities, doing a little at a time to start with.
  • Use painkillers such as paracetamol or ibuprofen, remember to check they are safe for you. They will reduce your pain, allowing you to remain active.  If you have any concerns speak to a Pharmacist or your GP.
  • Apply an ice pack to the affected area for 10-15 minutes at a time.  Ensure you wrap the ice in a towel and check the skin regularly to check for ice burns.
  • Use supportive footwear rather than flat shoes for example - try a supportive shoe that has a slight heel. 
  • Start a gradual loading and strengthening exercise programme (see advice below).
  • Self-refer yourself to see a physiotherapist if required.

What will physiotherapy do?

  • A physiotherapist will take a thorough history of your symptoms and will conduct a physical examination of the area to confirm the diagnosis.
  • In the early stages only gentle exercises would be recommended and treatment remains focused on pain relief, advice and education.  Often trying to force the ankle to move in the painful stages can just make it more painful and is not beneficial.
  • The main aim of physiotherapy is to restore strength and function to the ankle and surrounding muscles. Treatment will be based on active rehabilitation, focusing on strength and flexibility.
  • Your physiotherapist will create an individual and progressive exercise programme to address your individual needs. We have provided some exercises for you in the resources section, if you want to.

 

 

 

 

 

 

 

 

 

 

 

 

 

Symptoms to check

Click the plus sign to see a list of problems that could be a sign you may need to be checked urgently

Get advice from 111 now if:

  • your ankle is very painful and you cannot put any weight on it
  • you have direct injury to the ankle and it has become very swollen very quickly
  • your ankle is badly swollen or has changed shape
  • you heard a snap, grinding or popping noise at the time of injury
  • you have a very high temperature, feel hot and shivery, and have redness or heat around the ankle – this can be a sign of infection

111 will tell you what to do. They can tell you the right place to get help if you need to see someone.

Go to 111.nhs.uk or call 111.

Immediate medical advice is available by contacting NHS 111

Exercises & Resources area

Exercises & Resources

If you already have a diagnosis from a medical professional you may find some of the following links more helpful

 

 

5 star service. An outstanding service by all staff. They have identified my symptoms with great professionalism & empathy. Best health care and results I have ever had.

Excellent, supportive and professional approach. Could not achieve these results on my own! Thank you.

Everyone was so friendly and helpful. Wonderful experience.

Having formerly been a rugby player needed physiotherapy on a number of occasions I have never has as comprehensive a diagnosis and treatment as I have had from Alison Starkey. She was excellent.

Shafeeq Younus was very knowledgeable and courteous. Made me feel so much better mentally. Nothing could be improved.

Very helpful. Exercises really seemed to work for me.

Yohann & Diane are brilliant. Yohann was the only one who realised I had, had a mini stroke, if it hadn't been for him I don't know where I would be today. Diane was brilliant today, she really helped me and calmed me down.

Bart (Klimek) was great, feel like the exercises he gives are helping loads and I'm getting sorted.

Excellent service. Good follow up each time with the care given. All instructions for therapy were very clear.

Within days of attending I was doing exercises, more movement and less pain and everything was explained to me in great detail.

Referral Information

If your ankle pain persists, or you are not sure what to do, you can self-refer to see a local physiotherapist who can help you with your problem.

Refer