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Achilles Tendinopathy

Manifesting as lower calf pain or heel pain

Achilles Tendinitis or Tendinopathy?

What is Achilles Tendinopathy?

Achilles tendinopathy literally means that there are some changes to the Achilles tendon itself. Such a term might get confused with Achilles Tendinitis which normally indicates that there is an active inflammatory process going on but might not be the case all the time. Achilles tendinopathy normally presents as a pain in the back of the heel which is usually from the gradual onset of symptoms rather than a single traumatic incident.

How does Achilles Tendinopathy present?

Symptoms of Achilles Tendinopathy

Symptoms can include:

  1. Sharp pain at the back of the heel radiating upwards
  2. Tenderness over the Achilles tendon and the back of the heel bone 
  3. Sharp pain with hopping or high-impact exercises
  4. Tightness upon waking in the morning
  5. Presence of a warm-up effect. Pain disappears after warming up for the activity
  6. Pain when taking the first step upon waking or sitting

Insertional and mid-portion tendinopathy

Types of Achilles Tendinopathy

Achilles tendinopathy can be further differentiated into 2 main types: mid-portion or insertional. The difference lies in the location of the pain: mid-portion indicates that it is in the middle of the tendon itself whilst insertional refers to where the tendon inserts into the heel bone.

What causes Achilles Tendinopathy?

Anyone at any age can be affected by Achilles tendinopathy, however it generally affects the active and older population more. It usually is a result of a sharp increase in training load or physical activity after a period of laying off. However,factors such as obesity, diabetes, having a family history of tendinopathies or prolonged steroid use can increase an individual’s risk of getting Achilles tendinopathy.

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Difference between Achilles Tendinopathy and Plantar Fasciopathy

The first difference lies in the location of pain: whilst pain in the back of the heel usually indicates an Achilles tendinopathy, pain on the sole of the foot and along the arch indicates the presence of a plantar fasciopathy. 

The second difference is the structures being implicated or affected: Achilles tendinopathy affects the tendon at the back of the calf which connects the calf muscle to the heel whilst plantar fasciopathy affects the plantar fascia (thick band of connective tissue) at the sole of the foot

That being said, both conditions can occur together and are usually a result of an increase in activity or even sometimes a change in footwear. Both conditions may also manifest itself because of an underlying weakness in the hip muscles, thereby increasing the load on the plantar fascia or achilles tendon.

Treatment for Achilles Tendinopathy

The Physiotherapist will carry out an assessment of the ankle specifically and examine the whole lower limb to ensure that there are no significant deficits up the kinetic chain. We will assess calf strength and flexibility to determine what needs to be addressed. Physiotherapy can assist with reducing pain at the achilles tendon, offloading the tendon and strengthening the calf muscles.

Treatment may include but is not limited to:

FAQ about Achilles Tendinopathy

What is Achilles tendinopathy

Achilles tendinopathy refers to a combination of changes affecting the Achilles tendon usually due to overuse and excessive chronic stress upon the tendon. It can be seen both in athletes and non-athletes. It may or may not be associated with an Achilles tendon tear. A lack of flexibility or a stiff Achilles tendon can increase the risk of these injuries.

The precise cause of tendonitis remains unclear. Even though tendonitis of the Achilles tendon is often connected to sports activities, the ailment is also often found in people who do not practice sports. The biggest cause is the excessive overburdening of the tendon. A light degeneration of the Achilles tendon can be latently present, but the pain only appears when the tendon is overburdened. It is also noted that the ailment is usually not preceded by trauma.

What causes Achilles tendinopathy?

Achilles tendinopathy can happen for a myraid of reasons. One of the more common reasons we hear in clinic is the sudden overload of the tendon. This might look like a sudden increase in physical activity like running or jumping. Sometimes, it may be because of pooer hip-knee-foot control which may increase the load around the Achilles tendon, and thereby cause pain.

How is Achilles tendinopathy treated?

Depending on it’s insertional achilles tendinopathy or mid-portion achilles tendionpathy, the treatment of your heel pain might differ slightly. We may utilise the Alfredson achilles tendinopathy rehabilitation protocol which utilieses slow, controlled movement to begin loading the tendon, hence influecing the behaviour of the tendon and thereby reducing pain.