Achilles tendinopathy

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Download Info Sheet

Achilles tendinopathy is a broad term that covers painful conditions that cause damage to the Achilles tendon, characterized by a focal loss of normal fiber structure. The two main areas of damage are the Achilles midportion and the Achilles insertion. The cause, symptoms and treatment of each condition may differ and they will therefore be described separately.

Symptoms

Midportion

Pain in the Achilles tendon that can be of sudden or gradual onset. Severity of the pain is widely varied causing minimal to severe disability. With clinical assessment, pain is commonly felt with palpation or squeezing the Achilles approximately half way up the tendon.

Insertional

Pain is located at the base of the posterior heel given the close relationship between the insertion of the tendon, the bursa at the back of the heel and the heel bone. There may be a bony prominence and inflammation at the site.

Causes

Injury of the Achilles occurs when the load applied to the tendon exceeds its capacity. This may occur in a single episode or over a period of time i.e. with overuse. Latest research suggests this occurs without the presence of inflammation; however inflammation of surrounding structures may occur, particularly with insertional tendinopathy.

Common causes of overuse in the Achilles may include:
• years of running
• increase in training or activity (speed, distance and gradient)
• decreased recovery time between runs
• excessive foot pronation (inward roll)
• running on a cambered surface
• soft footwear
• calf muscle weakness

Treatment

Midportion

The focus of treatment for midportion tendinopathy is to strengthen the tendon and promote healing. The following may be prescribed by a podiatrist:
• Heel drop exercises
• Nitric oxide donor therapy (GTN patches for 12-24 weeks)
• Soft tissue therapy and electrotherapy (including shock wave therapy)
• Orthotics to correct foot posture
• Sclerosing injections and surgery

Insertional

Isolated treatment for insertional tendinopathy is less successful than for midportion tendinopathy.
However, combined exercises and injections may be useful.

Treatment for insertional Achilles tendinopathy should focus on unloading the region. This may achieved by wearing heel lifts worn inside both shoes and/ or with the use orthotics to correct foot posture. Night splints may also be used to maintain the ankle at 90 degrees during sleep.

Other treatment may focus on symptoms arising from the retrocalcaneal bursa, including:
• Non-steroidal anti-inflammatory medication
• Cortisone injections into the bursa
• Surgery in the presence of a Haglund’s deformity or bursitis when conservative measures fail

For chronic pain tendon pain for longer than three months shock wave therapy may be recommended to promote healing of the tendon. Shock wave therapy is new to our Port Melbourne location, Bodycare Podiatry.