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Achilles Tendinopathy: Causes, Treatment and Recovery

There’s a small part of your body named after one of Greek mythology’s most famous warriors. Achilles’ mother wanted her son to be immortal so she held him by his heel and dipped him in the River Styx. However, Achilles remained vulnerable in the one part of his body not touched by the waters: his heel.

The Achilles tendon takes its name from this story. Tendons are tough bands of fibrous connective tissue that connect your muscles to your bones. The Achilles tendon is the largest tendon in your body, connecting your calf muscles to your heel bone.

You rely on this tendon every time you use your foot. You use it to point your toes, rise up and push off to propel yourself forward. Every time you walk, run, climb stairs, jump or rise up on your tiptoes, you’re employing your Achilles tendon.

Tendons are strong enough to withstand great stress. Your Achilles tendon, for example, handles the stress of running and jumping with aplomb, most of the time. But it can develop tendinopathy due to overuse or degeneration.

What is Achilles Tendinopathy?

Achilles tendinopathy refers to a painful inflammation of your Achilles tendon.

There are two main types of Achilles tendinopathy:

Insertional: This affects the lower portion of your heel where the tendon attaches to your heel bone. You can develop insertional Achilles tendinopathy whether you’re active or inactive but it’s more common if you’ve overused the tendon for many years in sports such as long-distance running or sprinting.
Non-insertional or mid-portion: This affects the middle portion of your tendon where the fibres have begun to swell and thicken due to tiny tears. It’s most common in younger, more active people.

What Causes Achilles Tendinopathy?

It’s rarely a sudden injury. Most of the time, Achilles tendinopathy occurs due to overuse, which progressively weakens the tendon.

You’re more likely to develop Achilles tendinopathy if you:

Are male
Are getting older
Are putting extra strain on your tendon due to flat arches in your feet, tight calves and obesity
Have psoriasis or high blood pressure
Have taken a type of antibiotics called fluoroquinolones.
Are using inappropriate footwear or worn out running shoes
Suddenly increase your activity levels – perhaps you’ve started a new fitness regime and are now running further and more frequently than you usually do.
Have a bone spur – a bony overgrowth where the tendon attaches to your heel bone can rub against the tendon and generate pain.

What are the Symptoms of Achilles Tendinopathy?

If you’ve developed Achilles tendinopathy, you may experience symptoms such as:

Pain and stiffness along the tendon, often worse in the mornings (that’s because, as soon as you get up, the Achilles tendon has to move through its full range of motion so you can walk)
Heel or tendon pain that gets worse with activity
Significant pain 24 hours after exercising
Ongoing swelling around the tendon that becomes more extensive after exercise.

Tendinopathy means your tendon is inflamed but intact. But there is another, much more serious, tendon injury called a rupture when the tendon snaps, often with an audible ‘pop’. If you suspect you have a ruptured Achilles tendon then seek urgent medical attention.

What’s the Treatment for Achilles Tendinopathy?

Treatment for Achilles tendinopathy may include:

Medication to manage pain and inflammation
Orthotics inserted into your shoes to correct any mechanical issues, cushion your heel and slightly elevate it to reduce strain on your tendon
Exercises to strengthen the tendon and its associated structures.

There are many things we’re still learning about tendinopathy. Our current thinking is that it exists along a continuum with three stages:

Reactive tendinopathy
Tendon dysrepair
Degenerative tendinopathy.

Treatment for the early stages of Achilles tendinopathy aims to move you back along this continuum. By modifying your activities to reduce the load on your tendon, you may be able to turn tendon dysrepair to reactive tendinopathy and ultimately back to a normal tendon.

The prognosis is less positive by the time you’ve reached the stage of degenerative tendinopathy. There may be irreversible changes and significant thickening. That may happen if you’ve had problems with this tendon over many years as you’ve got older. It can also happen if you’re younger but have continued to overload the tendon instead of cutting back.

Exercises for Achilles Tendinopathy

Achilles tendinopathy exercises focus on:

Isometric loading:
- These are stabilising exercises that involve holding a position rather than moving.
- Exercise – Achilles tendon raises: place one hand on a wall in front of you for balance then rise up onto your tiptoes, hold, sink back down then repeat. You can do this on one leg or both legs together depending on your condition.

Isotonic loading
- These are strengthening exercises that involve moving against a weight or load to increase strength in your tendon and surrounding muscles.
- Exercise 1 – seated calf raise: Sit on a chair with your toes on a little ledge (a book or a thick yoga mat will do). Place a weight on your knees. Drop your heels down then raise them and repeat.
- Exercise 2 – standing calf raise: Stand on a ledge or step, ensuring you have something to lean on. Drop your heels, hold, then raise back to a neutral level and repeat.

Plyometric loading
- These are quick, powerful movements, reserved for when your tendinopathy has improved considerably and you are preparing to return to your preferred sport.
- Exercises: Skipping, playing hopscotch or jumping.

How Can The Brisbane Spine Clinic Help?

There is no ‘one-size-fits-all’ approach to recovering from Achilles tendinopathy. That’s why you need a skilled physiotherapist to assess your condition, prescribe the right exercises at the right intensity for you, and guide you through each stage of recovery.

At The Brisbane Spine Clinic, we love to help people recover from setbacks like tendinopathy. We tailor our treatment to your unique situation. Some people want to get back to playing a sport like volleyball, others want to return to running while others may do less intense exercise and simply want to go about daily life without pain in their Achilles tendon.

Whichever group you fit into, we’re here to help you using evidence-based, personally tailored treatments to improve your mobility and quality of life. Please make an appointment today.