There are two types of Achilles Tendinitis:
Insertional Achilles tendinopathy
- Pain at the bottom of the Achilles tendon (where it connects to the heel bone)
- Caused by compressive forces of the tendon on the heel bone when the ankle is dorsiflexed (foot flexed upwards)
Mid-portion Achilles tendinopathy
- Pain 2-6cm up from the bottom of the Achilles tendon
- Usually caused by overuse of the tendon
What causes Achilles tendinitis?
- Placing more load/stress on the tendon than it is capable of
- A sudden increase in amount/type of activity or gradual overuse
- Recent antibiotic use (fluoroquinolones)
Common complaints:
- Gradual onset of pain
- Pain with taking first steps in the morning
- Feeling of calf stiffness/tightness
- Pain to touch the back of heel or Achilles tendon
- Pain with jumping, squatting, running, going up and down stairs
- An increase in pain the day after lots of exercise
- Pain slowly resolves with rest, but returns with activity
How can therapy help?
Assessment
- A review of your current training regimen and any recent changes
- Markerless motion captures movements to determine range of motion and strategies used for squatting, jumping, landing, etc.
- Strength testing of the lower limb muscles to determine a baseline starting point and any imbalances
- Running analysis (if this is an activity you do)
- Determining a treatment plan based on your specific goals
Treatment
- Load management of the tendon:
- Reducing or modifying activities (reducing frequency, volume, and/or high-stress activities) to a point that the tendon can tolerate
- A progressive loading program to help the tendon adapt to the demands of your sports/lifestyle
- Pain relief exercises and advice
- Manual therapy and exercise to address any range of motion or strength deficits determined in the assessment
- Heel lifts are sometimes recommended to reduce compressive forces on the tendon (for insertional tendinopathy)
For a more detailed explanation on tendon pain and injuries, check out our tendinopathy blog.
