The Achilles tendon is also referred to as the calcaneal tendon. The Achilles tendon is an incredibly strong fibrous band and is found at the back of the lower leg.
The Achilles tendon connects the plantaris, gastrocnemius and soleus muscles (the large calf muscles) to the calcaneous (heel) bone. The tendon that connects from the gastrocnemius to the calcaneous is longer than the soleus part. The Achilles tendon helps give the power when pushing off, and allows for pushing up off the toes (for example when on tippy toes).
Achilles tendinosis is inflammation of the Achilles tendon. Through prolonged activity and over time the Achilles tendon can start to degenerate. The tendon begins to fray (it is made up of strands of collagen, which gradually start to separate). As these strands separate, the achilles tendon weakens, which can over time or under sudden exertion, completely rupture.
It is is estimated that Achilles tendinosis makes up approximately 12% of running injuries. From the age of 25 the Achilles tendon begins to degenerate. The most common age for Achilles tendinosis is from mid-thirties to mid-forties. This is the age when a lot of people resume activity after a substantial period of inactivity in their lives, as a result of time pressures, balancing work and young families. This explains its prevalence as a sports injury in runners. Complete rupture of the Achilles tendon is more prevalent in men than women.
Many factors can cause Achilles tendonitis, and it is a common over use injury in sport.
It can be caused by:
Incorrect footwear, (e.g. high heels). High heels cause the shortening of the tendon and calf muscles.
A change in training surfaces, in particular concrete which is unforgiving.
Weak calf muscles.
Climbing hills, jumping, and any action that causes the pushing off action.
Increased running and walking, with insufficient warm up or preparation, (e.g. playing tennis after minimal activity).
Not allowing enough rest time between exercises, for instance, excessive running every day, and not allowing sufficient recovery time. The calf muscles (gastrocnemius and soleus) can become stiff and tight, which results in poor flexibility and are more likely to tear.
There are 3 types of Achilles Tendonitis:
The pain is felt at the back of the ankle and comes on gradually and can occur over a few days.
The Achilles tendon is tight and stiff, but this stiffness and pain eases during walking or with the application of heat. This is because as the Achilles tendon warms up it starts to loosen and become less tight, and as a result less painful.
The tendon can be tender and warm to touch, but pain will reduce with rest.
Pain develops gradually over a few weeks/months.
Unlike acute Achilles tendonitis the pain does not go away with exercise.
Pain is particularly notable when walking or climbing up hills.
The Achilles tendon is stiff and sore particularly first thing in the morning.
You can occasionally hear a cracking/creaking sound when pressing the Achilles tendon.
The Achilles tendon might feel thick and have small nodules or lumps where thickening has occurred. This happens as a result of the build-up of scar tissue caused by the rupture of the Achilles tendon, which then forms scar tissue as it heals (these are the nodules). This is often felt a few cm’s above the heel.
The tendon can be red and tender to touch.
Complete Rupture of the Achilles Tendon:
There is a sensation of being hit from behind, in the back of the leg.
Where there is complete rupture of the Achilles tendon a gap can be felt.
The ruptured area is tender to touch, and is swollen, due to increased bleeding to the area.
The patient will find it difficult to walk on tip toe or plantar flex (point the toe).
The Thompson Test can be performed to assess the extent of damage. The patient lies on their front, with knee slightly bent. Complete rupture is suspected if the foot fails to plantar flex when the calf is compressed.
Rest: to prevent further damage.
In the sub acute (3 days to 3 weeks) and the chronic stage (3 weeks to 2 years) it is important that training should be adapted to avoid jumping or any exercises that put excessive strain on the achilles tendon. A physiotherapist or sports massage therapist can advise when exercise should be resumed and what exercise would be appropriate.
Cryotherapy: Ice, can be applied for 10-15 minutes, every 2-3 hours in the acute and sub- acute stage (frequency can be reduced according to recovery, and can be continued for as long as deemed necessary). In the sub-acute stage (3days – 3 weeks) heat therapy can be applied.
Compression: to reduce swelling and restrict movement.
Strapping provides support. In a complete rupture the doctor might prescribe a cast to provide stability.
Elevation: gravity will assist lymphatic drainage and aid venous return.
The application of Kinesiology Tape using the lymphatic fan technique is increasingly being seen as a valuable method of dramatically reducing swelling.
NSAIDS (anti-inflammatories) and paracetamol can be taken to aid pain relief. Medical advice should be sought, in case of possible side effects.
Orthotics can prevent over-prontation. It is therefore, worth consulting a podiatrist, who can perform gait analysis and advise on appropriate foot wear.
A doctor or physiotherapist might recommend an MRI scan to assess the extent of rupture. In severe cases surgery might be performed.
A physiotherapist might prescribe ultrasound treatment, sound waves; which speeds up the repair process, by breaking down tissues and stretching them. It can also help alleviate pain.
Massage can help aid recovery, and improve joint mobility and range of movement. It should not be administered during the acute stage. If there is any underlying medical condition, such as a heart condition, it is important to seek medical advice before receiving massage.
A physiotherapist or sports massage therapist can recommend strengthening, flexibility and proprioceptive exercises in the sub acute and the chronic stage of recovery. Exercises should focus on strengthening, focusing on the gastrocnemius and soleus muscles, for example heel raisers. The intensity of the exercises should be increased gradually and in a controlled way.
Published: November 4, 2011Author: Sophia Cross, BA (Hons) MA