​ASKPHYSIO

• A tendinopathy is a condition whereby the tendon is degenerative, with loss of normal structure.  Abnormal vascularisation also leads the Achilles to being overly sensitive.

• There are two types of Achilles tendinopathy – midportion and insertional.  The mid portion of the tendon sits 2-3 cm above the heel.  The insertion part of the tendon is where the Achilles inserts into the heel.

• Achilles tendinopathy is an overuse condition characterized by gradual onset of pain in the Achilles.

• This is the largest tendon in the body. It attaches the calf muscles in the lower leg to the back of the heel (Calcaneus). There are two calf muscles, the Gastrocnemius and Soleus. These strong muscles allow us to rise up on our toes making them prime muscles used in walking and running.

• Pain is usually worse in the morning and eases with heat and exercise.  Pain reappears a few hours after physical activity.

Common causes include:

• Over pronation

• tight calf muscles

• poor tensile strength through the tendon and calf muscles

• hypomobile ankle and subtalar joints

• overtraining or change in intensity, duration, frequency

• incorrect or poor footwear

• previous Achilles strain or rupture

• genetic predisposition to tendon weakness

Achilles tendinopathy is an unfortunately common complaint seen in a physiotherapy clinic.

It is important to not let this injury go untreated as it can become a chronic problem very easily.  Early physiotherapy is vital, and the necessary rehabilitation must be provided and then adhered to to achieve an optimum outcome and prevent recurrence.

Following a thorough history taking and assessment, an eccentric loading program will likely be advised.  This is believed to increase the tensile strength of the tendon and effect change in the collagen structuring within the tendon.

Eccentric loading must be carried out diligently for a 12 week period.  Alfredson’s program which is widely accepted involves standing on a step, and raising up for the count of 5 seconds, and lowering for a period of 10 seconds.  180 repetitions are required.  Both the gastrocnemius and soleus muscles can be targeted separately by changing the knee position from straight to slightly bent.  Excellent results can be achieved with this program for mid-portion Achilles tendinopathies.  Insertional Achilles tendinopathies are renowned for being more difficult to manage.

Other treatment modalities utilized may include massage, acupuncture, electrical physical agents and joint mobilization.  Biomechanical assessment is very important and advice will be given about different methods for offloading the Achilles.