Overview

Achilles tendonopathy is a common overuse injury affecting the Achilles tendon, which connects the calf muscles to the heel bone. It occurs due to the repetitive strain placed on the tendon during activities such as running and jumping. Contrary to previous beliefs, this condition is not primarily characterized by inflammation but is more related to tendon weakness and dysfunction.

Causes

The Achilles tendon and calf muscles work as a vital unit during physical activities, absorbing and releasing energy with each stride. They are subjected to significant loads, with forces that can be as high as seven times your body weight during the push-off phase of a stride. This constant strain makes the Achilles tendon susceptible to overuse and injury.

Symptoms

1. Heel Pain: Achilles tendonopathy typically presents with sharp, incapacitating pain close to the heel. This pain can be severe and stabbing.

2. Pain Along the Achilles Tendon: Pain is often felt along the back of the lower leg, following the path of the Achilles tendon.

3. Swelling: In some cases, there may be mild swelling at the base of the tendon near the heel, along with redness.

4. Tenderness: Pinching the Achilles tendon may result in significant soreness, indicating a problem with the tendon.

5. Pain During and After Activity: Pain is often experienced during and after running or other physical activities. It's crucial to note that Achilles tendinopathy should not be ignored or pushed through; rest is essential.

6. Thickening: In chronic cases, a thickened 'lump' may develop along the tendon, especially when compared to the uninjured leg.

Treatment

Managing Achilles tendinopathy involves a combination of conservative approaches and, in some cases, medical intervention:

1. Rest: Reducing or avoiding activities that aggravate the condition is crucial to allow the tendon to heal.

2. Ice: Applying ice to the affected area can help reduce pain and inflammation.

3. Physical Therapy: A structured rehabilitation program can improve strength, flexibility, and function of the Achilles tendon and calf muscles.

4. Orthotics: Custom-made or over-the-counter shoe inserts may provide additional support and alleviate strain on the tendon.

5. Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used to manage pain and inflammation, but they should be used under medical supervision.

6. Injections: In some cases, corticosteroid injections may be recommended to reduce inflammation and pain.

7. Surgery: Surgical intervention is considered only in severe cases when conservative treatments have failed.

8. Shockwave therapy: Non-invasive procedure advocated by NICE Guidelines to stimulate the body's own natural healing process.

Prevention

To reduce the risk of Achilles tendinopathy:

1. Proper Footwear: Choose appropriate footwear for your activity and ensure a proper fit.

2. Gradual Progression: Avoid sudden increases in exercise intensity or duration.

3. Stretching: Incorporate calf stretching exercises into your routine.

4. Strength Training: Strengthen the calf muscles to provide better support to the Achilles tendon.

Conclusion

Achilles tendonopathy is a painful condition resulting from the overuse and strain of the Achilles tendon. Understanding the symptoms and seeking prompt treatment is essential to prevent further complications. With appropriate care, most individuals can recover from this injury and return to their normal activities.