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It is estimated that Achilles tendonitis accounts for around 11% of all running injuries. The Achilles tendon is the large tendon at the back of the ankle. It connects the two muscles, gastrocnemius and soleus, to the heel bone. The Achilles tendon can become inflamed for a number of reasons, the main reason being overuse. The Achilles tendon has a poor blood supply and, therefore, it is slow to heal.
Pain in the Achilles tendon is usually felt during exercise. Achilles pain will gradually come on with prolonged exercise but will go away with rest. Swelling over the Achilles tendon is common, as is redness over the skin. Sometimes a creaking or lumpiness is felt when you press your fingers into the tendon and move the foot.
In the early stages, the resultant discomfort and limping usually wear off after a few minutes. The diagnosis can be confirmed by pinching the Achilles tendon between the thumb and index finger, where at least one tender area should be felt.
It is very important to distinguish between foot pain caused by Achilles Tendonitis (tendinosis) and the more serious condition of partial or complete Achilles tendon rupture, which requires urgent medical attention (surgery or immobilisation). If the heel pain comes on suddenly while running or is accompanied by weakness, then suspect a full or partial rupture rather than Achilles Tendonitis/Tendinosis and seek medical help quickly. Complete ruptures are less common in distance runners than they are in other sports like Tennis and Squash.
It is uncertain what triggers this, but excessive ankle pronation and/or the rapid alteration in calf muscle action as the heel strikes and then toe-off occurs have both been put forward as possible causes.
Shoes that are too flat or worn out are thought to be a possible cause, as are shoes that do not adequately cater for the runners' specific biomechanical needs (e.g. over-pronation). A sudden increase in training load (particularly very long runs or speed/hill sessions) and tight calf muscles are both also thought to be potential factors.
Achilles tendonitis is an overuse injury and is often a case of too much, too soon. Running up hills will mean the Achilles tendon will stretch more than usual during each stride. This will not cause problems initially, but the tendon will fatigue sooner than expected. Flat/pronated feet can place an increased strain on the Achilles tendon. As the foot rolls in (pronates) and flattens, the lower leg rotates inwards, twisting and stretching the Achilles tendon.
The most important thing to do is to stop running for at least seven days when the injury first appears.
Ice packs should also be applied to the site of the heel pain, as although there is probably no inflammation, this may reduce the extent of tendon degradation.
Note that it is not generally recommended to take anti-inflammatory medication for this condition. Careful return to a reduced training program can then be attempted.
An assessment with a podiatrist from Footfix should be sought to review the cause of your Achilles tendonitis and a management plan devised to treat the condition. Your running regime may require modifying, as may your footwear.
'Running through' pain should be avoided. Continuing with the current, possibly harmful training regime that is causing the symptoms is likely to cause further damage and should be avoided.
The worst-case scenario is that the tendon snaps. This is also known as a complete rupture of the Achilles tendon. It can occur suddenly if vigorous exercise is attempted out of the blue, or it can occur after a long period of tendonitis. A completely ruptured Achilles tendon requires urgent attention.
Runners with all types of foot pain should also consider whether a new pair of shoes is required. Shoes wear out and lose their characteristics, but perhaps a change of make type or fitment should also be considered as the cause of the problem.
We may advocate that a heel-support/insole for in the shoe or full custom-made orthotic be utilised to treat Achilles Tendonitis problems. These will help to control excessive force being applied to the back of the heel bone and tendon.
An orthotic for Achilles tendinopathy (shoe insert) that reduces the amount of pronation (the foot and leg rolling inwards) can help reduce overstrain on the tendon.
Acute injuries can be treated with ultrasound over a couple of weeks to help relieve the initial symptoms. We usually see people for one to two treatments a week for up to four to six weeks, along with rehabilitation exercises this helps the acute injury.
Suppose this is a chronic issue that has not been resolved for over four months or keeps reoccurring. In that case, radial shock wave therapy may benefit the vascular response to the injured tissue and kick start the wound healing process again. You will require a treatment session once a week for three to six weeks. The healing process can then take 12 weeks to start a reactive healing response.
A newer form of therapy involves very high volumes of a dextrose and saline solution being injected into the Para-tendon, which effectively causes a stripping effect of the damaged tendons. This should always be completed under the guidance of ultrasound.
The podiatrist can provide footwear advice as to what is suitable for training.
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