What is Achilles Tendonitis?

The Achilles tendon is the large tendon at the back of the ankle. It connects the large calf muscles (Gastrocnemius and Soleus) to the heal bone (calcaneus) and provides the power in the push off phase of the gait cycle. The Achilles tendon can become inflamed through overuse as well as a number of contributory factors. The Achilles tendon has a poor blood supply which is why it is slow to heal.

It is estimated that Achilles Tendonitis accounts for around 11% of all running injuries.

Achilles Tendonitis can be acute or chronic. Acute Achilles Tendonitis may happen as a result of overuse or training too much, too soon especially on hard surfaces or up hills.

Symptoms of Achilles Tendonitis

Symptoms for acute inflammation of the Achilles tendon are:

• Pain on the tendon during exercise. Achilles pain will gradually come on with prolonged exercise but will go away with rest.
• Swelling over the Achilles tendon.
• Redness over the skin.
• You can sometimes feel a creaking when you press your fingers into the tendon and move the foot.

Symptoms for chronic Achilles Tendonitis are similar to those of acute tendonitis as well as:

• Pain and stiffness in the Achilles tendon especially in the morning. This pain may be described as diffuse along the tendon rather than specific.
• There may nodules or lumps in the achilles tendon, particularly 2cm above the heel.
• Pain in the tendon when walking especially up hill or up stairs.
• Chronic tendonotis differs from acute tendonitis in that it is more of a long term persistent problem.

Causes of Achilles Tendonitis

• Overuse. Too much too soon is the basic cause of overuse injuries, however other factors can make an overuse injury more likely. Running up hills will mean the achilles tendon has to stretch more than normal on every stride. This is fine for a while but will mean the tendon will fatigue sooner than normal.
• Overpronation or feet which roll in can place an increased strain on the achilles tendon. As the foot rolls in (flattens) the lower leg rotates inwards also which twists the achilles tendon place twisting stresses as well as stresses along its length.
• For women, wearing high heels consistantly and then expecting to run 5 miles in flat running shoes puts abnormal strain on the achilles tendon making it stretch further than it is comfortable.

Treatment of Achilles Tendonitis

The following guidelines are for information purposes only. Seeking professional advice before beginning rehabilitation is recommended. 

Massage Therapy

• Rest and apply cold therapy or ice (not directly onto the skin).
• Wear a heel pad to raise the heel and take some of the strain off the Achilles tendon. This should be a temporary measure while the Achilles tendon is healing.
• Apply Sports Massage using Trigger Point Therapy Techniques.

Trigger points should be at the top of the list during any examination for pain, numbness, and other abnormal sensations in the lower legs, ankles, feet or toes.

According to Doctors Janet Travell and David Simons in their widely acclaimed medical textbook, Myofascial Pain and Dysfunction: The Trigger Point Manual, referred pain is the defining symptom of a myofascial trigger point. When healthcare practitioners have had adequate training and experience, trigger points are easy to locate and treat .

If you look after this injury early enough you should make a good recovery. It is important you rehabilitate the tendon properly after it has recovered or the injury will return. If you ignore the early warning signs and do not look after this injury then it may bec ome chronic which is very difficult to treat.