The link between Covid-19 and Achilles Tendon pain

Grace Buchan Education


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For a large proportion of us, exercise is a crucial part of our lives and shapes who we are. Any niggle or injury that prevents us from being able to move and function day to day, can have a detrimental impact on our mental health, especially in COVID-19 circumstances where we are very restricted in where we can go and what we can do.

During the course of COVID-19, we have seen an influx in achilles tendon injuries as a result of tendon overload. This includes; working from home with no shoes on, less incidental movement throughout the day, sudden increases in walking and running and the change in surface from running on a treadmill to running outside.

The prolonged closure of gyms, rehabilitation centres and workplaces has meant that there is not as much exercise variety and people are substituting their normal routine for walking and running, as a way of getting out of the house. This has meant a loss of cross training in the form of swimming, gym workouts, pilates, yoga and fitness classes.

What is the achilles tendon and why is it so crucial?

The achilles tendon is a strong fibrous structure that connects the calf muscle to your calcaneus (heel bone). The function of the achilles tendon in walking and running involves plantarflexion of the foot which is crucial for the push off phase of gait when we are walking and running. The achilles tendon is vital in storing and releasing energy and has to withhold heavy loads of up to 6-7 times your body weight when running.

Why would I be experiencing pain?

Tendons are irritable structures that do not respond well to repetitive load with a lack of rest, inconsistency in training and sudden changes in training regime.
Achilles tendon pain can manifest in many different levels of pain and various stages from an early inflammatory stage to a prolonged chronic stage where the structure has calcified.

The most common precursor of tendon pain is when the load (walking, running or any given sport) exceeds the capacity and strength of the tissues, therefore resulting in an injury to this structure.

Other common causative factors of achilles tendon pain include:

  • An increase or change in your activity
  • Weak calves
  • Restriction in the ankle joint
  • Inefficient foot mechanics
  • Poor/under-supportive footwear

Why is my achilles tendon flaring up now during COVID?

  • Having a history of achilles tendon pain that hasn’t been managed properly in the first place can result in the recurrence of this injury.
  • An increase in activity or change in activity load, intensity and surface. This could be due to the closure of indoor facilities and rehabilitation centres.
  • Working from home, we are more sedentary than we usually would be in the workplace and there is less low intensity incidental activity.
  • Working from home in flat footwear such as slippers and in combination with working at a standing desk can increase pressure through the achilles tendon and heel.
  • Current walking and running footwear is providing inadequate support and are past their use by date.

What are some immediate changes I can make to help with my injury?

The treatment and management of achilles tendon pain is dependent on the stage of injury and the level of pain experienced. Below are some changes that can be made to target an irritable achilles tendon.

  • Reduce the INTENSITY and FREQUENCY of the aggravating load (walking or running every second day, decrease the pace of your walks and runs).
  • Allow 24-48hrs between runs to allow the tendon to recover and for tissue repair damage made.
  • Use a roller to roll out the calf muscles.
  • Use a ball (golf, spiky or lacrosse) to roll under the foot. Avoid the area of pain along the achilles tendon.
  • Update footwear. Runners typically only last between 600-800kms and compress at a quicker rate when worn for back to back days.
  • Get up from your home desk every 30 mins to move around, roll out your muscles and stretch.
  • Wear supportive shoes if working at a standing desk at home.

Management & prevention:

Gradual heavy loading (within tolerable pain range) is required to strengthen the tendon and prevent re-injury of the structure.
A weighted calf raise is a vital exercise for building strength in the lower leg and foot.
Implementing calf and plantar fascia rolling into your cool down and recovery routine post-exercise is a great way to alleviate tightness and symptoms.
Incorporating a second pair of runners to alternate between, can reduce repetitive strain through the muscles in your legs.

What we can do as podiatrists to help:

  • Injury screening and assessment of walking/running biomechanics.
  • Training load management + running/walking programs.
  • Taping and offloading.
  • Footwear education and assessment.
  • Orthotic therapy.
  • Prescription and guidance on strengthening exercises.
  • Shockwave therapy.

If symptoms are to persist, then book in online for a telehealth or face to face consult with one of our professionals.