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Achilles tendonitis treatment does not have to be difficult. When experiencing pain related to Achilles tendonitis, you want answers. Learn what you can do to get back on your feet and reduce the risk of a more serious injury like an Achilles tendon rupture.




What is Achilles Tendonitis?

The Achilles tendon is the thick tendon formed by the two muscles of the calf: the gastrocnemius and the soleus. These two muscles function in plantar flexing the ankle. This is the motion that occurs when you rise up on to your toes. The Achilles tendon is located on the back of the ankle and functions in attaching these muscles to the calcaneous or heel bone. Because the tendon is active with walking, running, and jumping, it is susceptible to overuse and micro tears.

Achilles tendonitis technically means inflammation of the Achilles tendon. However, tendon pain does not always mean the tendon is inflamed. For this reason, tendonitis can also be referred to as tendinopathy. Most often, pain in the Achilles tendon is related to micro tears of the tendon, commonly called tendinosis.


achilles tendon


Occasionally, not only will the tendon become irritated but the sheath around the tendon can also become thickened and inflexible. When inflammation of the sheath occurs the ability of the sheath to glide over the tendon becomes restricted, leading to increase irritation and pain.


Causes of Achilles Tendonitis

Causes of Achilles tendonitis are multifold. Muscle tightness, specifically the gastrocnemius and soleus, is a significant cause. Overuse is also a strong factor. Often we talk about the ‘training error’ in relation to overuse. It may have been a change of exercise/activity intensity, duration, frequency that initiated the symptoms. A change of surface or even a change of footwear can create extra tendon stress and lead to inflammation.

Foot type can also be a significant component of Achilles tendonitis pain, specifically when your foot over-pronates. Symptoms are more easily associated with foot type when not wearing appropriate footwear.

Finally, a lack of eccentric strength of the tendon can also influence the development of tendonitis.


Typical Symptoms of AchillesTendonitis

Typical symptoms of Achilles tendonitis can include tendon swelling, tenderness with palpation of the tendon, redness around the tendon, pain with walking, jumping, running, stair climbing and pain with rising up on to the toes. The calf muscle can also feel tight or restricted.

Chronic tendonitis of the Achilles is a concern in that micro tears can occur, increasing the risk of an

Achilles tendon rupture. Rupture of the Achilles tendon is a surgical situation with recovery requiring months. For this reason alone, seeking treatment for Achilles tendonitis is strongly encouraged.


Achilles Tendonitis Treatment

Although Achilles tendonitis may not be related to inflammation of the tendon, anti-inflammatory medication is frequently used in Achilles tendonitis treatment. Oral anti-inflammatories and topical anti-inflammatory creams can be helpful in reducing Achilles pain (consult your doctor about medications).

Ice can be used to help minimize pain associated with Achilles tendonitis. Ice massage is an effective type of icing as the tissues are quite superficial. To use ice massage, fill Styrofoam cups with water and freeze them. Once the water is frozen, peel off the rim of the cup to expose the ice. Massage the exposed ice over the tendon for 5 minutes.


ice massage


Another key aspect of Achilles tendonitis treatment is to avoid all aggravating activities. If running, walking, or jumping increase pain, limit these activities until the pain improves.

A temporary means of reducing stress on the Achilles is to utilize a heel lift. Lifting the heel decreases the stretch on the Achilles thus decreasing stress on the tissues. Even if the symptoms involve only one side, make sure to put the lifts in both shoes to keep the leg lengths even. The use of the heel lift should be temporary, therefore, once your pain improves, start to wean off from wearing them.


heel lift


Another aspect of Achilles tendonitis treatment is shoe wear selection. A flatter foot, or a foot that pronates, is more susceptible to irritation of the Achilles. A foot that flattens is generally more flexible, requiring greater work from the calf muscle and Achilles to propel the body forward. For chronic situations, consider using a shoe insert to support the foot. A good brand of over-the-counter inserts is Superfeet and is generally sold at sporting good stores. I recommend these inserts often and have received great results.

For significant cases of Achilles tendonitis, the use of an immobilizer may be the best way to allow the tendon to rest and reduce the inflammation. If an immobilizer is prescribed, this is a sign the tendon needs significant rest to heal.


Physical Therapy

Chronic Achilles tendon pain will result in decreased flexibility of the tissues. Pain free stretching therefore is an important component of a successful treatment program. Addressing the lack of flexibility of both the gastrocnemius and solues should be part of the Achilles tendonitis treatment protocol.

To stretch the gastroc, stand facing the wall with the leg to be stretched behind. Keeping the knee straight lean forward, feeling the stretch in the calf. Make sure to keep the foot pointed forward and not allow the foot to rotate out to the side. Hold this stretch for 30 seconds and repeat.

To stretch the soleus, repeat the same position but instead of keeping the knee straight, allow the knee to slightly bend. Try to keep the heel on the ground. Hold this position for 30 seconds and repeat.

gastroc stretch

soleus stretch

As symptoms improve, strengthening of the calf and supporting muscles is essential for returning to activity and minimizing the potential return of symptoms. Tendonitis is specifically associated with the lack of eccentric muscle strength.

Eccentric strength is the strength of the muscle as it is contracting but lengthening. Eccentric strength training is thus an essential component in Achilles tendonitis treatment in order to return to full function and preventing re-occurrence of tendonitis. Research indicates that the best dosage for performing eccentric training is to do 3 sets of 15 repetitions. In addition, it is OK to perform the exercise while experiencing some pain.

heel raises


Summary

• Achilles tendonitis pain is often associated with micro tears of the Achilles tendon and may or may not involve the tendon sheath.

• Typically activities such as running, walking, jumping, and negotiating stairs will be painful.

• Muscle tightness, foot type, shoe wear, overuse, and a lack of strength can all influence the development of Achilles tendonitis.

• Seeking treatment for Achilles tendonitis is strongly encouraged as chronic tendonitis increases the risk of Achilles tendon rupture.

• Typical Achilles tendonitis treatment can include using oral and topical anti-inflammatory medication, ice massage, use of a heel lift, and wearing supportive shoes.

• Avoid activities that cause pain and incorporate stretching and eccentric strengthening exercise exercises into your daily routine.

Achilles tendonitis treatment does not have to be difficult. Although tendonitis can be temporarily limiting, by following the above recommendations you can help get back to normal activity in no time.





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References

Br J Sports Med. 2011 Nov 10. [Epub ahead of print] A 5-year follow-up study of Alfredson's heel-drop exercise programme in chronic midportion Achilles tendinopathy. van der Plas A, de Jonge S, de Vos RJ, van der Heide HJ, Verhaar JA, Weir A, Tol JL

CMAJ. 2011 Jul 12;183(10):1159-65. Epub 2011 Jun 13. Conservative treatment of chronic Achilles tendinopathy. Scott A, Huisman E, Khan K

J Foot Ankle Res. 2011 May 30;4:15. Lower limb biomechanics during running in individuals with achilles tendinopathy: a systematic review. Munteanu SE, Barton CJ

Clin Sports Med. 2010 Jan;29(1):157-67, table of contents. Rehabilitation of ankle and foot injuries in athletes. Chinn L, Hertel J.

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