Orthopaedic Surgery - Achilles Tendinopathy

What is Achilles Tendinopathy?

The Achilles tendon is the large tendon at the back of the ankle. It connects the two calf muscles (Gastrocnemius and Soleus) to the heel bone.

As with joints, the Achilles tendon is also subject to wear and tear resulting in Achilles Tendiopathy.

What are the causes?

Achilles tendinopathy (otherwise known as Achilles tendinitis) is due to repetitive microtrauma or overloading causing the tendon to become thicker and swollen, about 2-5cm above where it inserts into the heel bone (Calcaneum).

An Ultrasound or MRI scan can be performed to confirm the diagnosis.

Common causes include:

• Overuse of Achilles tendon i.e. running, dancing, sports
• Walking for prolonged periods in inappropriate footwear
• Having poor flexibility such as tight and underdeveloped calf muscles or hamstrings
• Conditions such as diabetes, arthritis and obesity
• Injury to the tendon

What are the symptoms?

The main symptoms include pain, swelling, stiffness and weakness of the Achilles tendon.

These symptoms tend to develop gradually and are usually worse when you first wake up in the morning. Some people may have pain during exercise, but most people have pain after exercise.

Runners may notice pain at the beginning of their run, which then tends to ease and become more bearable, followed by an increase in pain once they stop.

How is Achilles Tendinopathy treated?

As a first line of treatment, the following techniques may provide benefit:

Relative rest: Complete rest is not recommended as some stress is required to maintain the health of the foot bones and soft tissues. Exercise is also important for weight loss management, which in turn decreases stress on the foot.

To rest the tendon, avoid running, long periods of standing or walking and high impact activity. These can be temporarily replaced by swimming or cycling. Return to full activity once the symptoms start to improve should be gradual.

Medication: Over the counter, non-steroidal anti-inflammatory drugs (e.g. Ibuprofen) can be helpful in the initial stages to reduce the pain and swelling.

Ice: Applying ice/cold packs to the sore area for 15 - 20 minutes can help to relieve pain. You should leave at least two hours between applications and place a damp cloth between the cold pack and your skin to prevent ice burns.
 
Physiotherapy: Regular stretching and eccentric exercises can help to ease symptoms. Eight out of ten patients find the pain eases with these stretching exercises. Hold each stretch for 30 seconds and repeat 3 times.

Calf stretches - Place the affected foot behind, keep the back leg straight and bend the front knee. This will allow you to lunge forward stretching the back of the calf.

Eccentric exercise - Start by standing on a step with both heels over the edge. Rise up onto the tiptoes. Then let the weight of your body stretch your heels towards the floor for 30 seconds.

Footwear: Avoid walking barefoot. Use well cushioned shoes for comfort and shock absorption.

Orthotics: Can provide relief by counteracting irritation to the Achilles tendon through support.

Are there any other treatment options?

Dry Needling

In long-standing cases that fail to settle with the above treatments, dry needling can be offered.

Dry needling involves repeatedly introducing a fine needle in to the abnormal tendon under ultrasound guidance. This causes mild trauma to the tendon, breaks down adhesions and promotes better healing.

Surgery

Surgery is rarely required. It is only considered for a small number of patients who fail to improve after 12-18 months of treatment.

This would involve exposing the Achilles tendon. The tendon is then opened along its length and the degenerative tissue is removed. The remaining tendon and the sheath are then repaired. The skin is then stitched and a below knee backslab is applied to rest the tendon for 4-6 weeks.

If you need any further information

Please inform staff of any concerns or questions you may have. We will do our best to answer your queries quickly.