Achilles Tendinosis - Tendonitis

Is the result of excess stress / strain directed to the Achilles tendon causing tearing of the tendon / sheath and thus fiber degeneration within the tendon (inflammation is infrequent unless in partial ruptures, hence why the term "Tendonitis" is less appropriate than "Tendinosis"). The area of injury is usually felt roughly 6cms (in average adult) up from the insertion of the heel bone (see diagram below). It is here where the tendon is at its most vulnerable. Pain also can be felt at the attachment point (insertion) at the back of the heel.

 

 ♦ Causes:

There are a number of causes which usually include at least one of the following:

- Dynamic activity applying a lot of force to the ankle area, e.g. jumping, moving side to side or kicking – particularly if the area is in a cold / unwarmed state.

- A history of having tight calf muscles from either lack of calf stretching or demanding training can direct stress to the Achilles via improper foot function – see next point...

- Improper foot mechanics which involves excessive (degree & / or time) foot pronation (inwards motion) can put excess strain on the Achilles via bending it too much or causing it to go through a whiplash motion.  By this I mean the Achilles is directed from side to side causing injury roughly 6cm (in average adult) up from the insertion of the heel bone.

- Used / inappropriate footwear or footwear which is not suitable for either yourself and / or the sport you are playing can cause stress to the Achilles.  Women wearing high heel shoes during the day and then exercising in lower heel sports shoes can cause too much stress to the Achilles and calf region.

- Wearing of track spikes too much too soon in your training phase can prevent the calf and Achilles to adapt to the increased forces thus stress to this area.

- Training errors i.e. inappropriate training adaptation e.g. doing too much hill training (running up and down hills) too soon.

- Pre-existing scar tissue from a previous injury to the Achilles can predispose the Achilles to future strain.

 

 Treatment:

After the initial injury, the RICE program is the first action to take, e.g. Rest, Ice, Compression, Elevation.

- Heel drops (eccentric exercises) - gently lowering the heel from a raised position (i.e. standing on toes, or at edge of step) in a slow and controlled movement (i.e. see figures 5 and 8 in below diagram). Once the Achilles starts getting stronger and less symptomatic you can start doing more dynamic eccentric loading activity - see last point.

- Gradually and gently stretching the calf muscle region.

- Mild massaging of the area from heel bone to calf muscle (help break down scar tissue).

- Getting rid of inappropriate footwear.

- If faulty foot mechanics is present, then the prescription of foot orthotics will be needed.

- Sometimes a (temporary) heel raise inside the shoe does help in taking the excess stress away from the Achilles.

- More dynamic eccentric loading exercises via walking backwards (i.e. a series of 50m reps), then once the region is getting stronger you can proceed to running backwards.