What is Achilles tendonitis?
Achilles tendonitis, also known as Achilles tendinopathy, is the medical term for tissue damage to and inflammation of the Achilles tendon. The tendons in the body connect the muscles to the bones; their structure is very similar to a rubbery stretchy cord making it strong, durable and flexible. Where the tendons attach to the bone they are covered in a sheath, that is lubricated on the inside, allowing the tendon to move in and out effortlessly. Joint movement is the end result of muscle fibres contracting and pulling on the tendon, which in turn tugs at the bone producing the movement. The tissue damage and inflammation that causes tendonitis occurs around the tendon itself, any damage to the tendon sheath is termed tenosynovitis, although it is very common for both conditions to be present at the same time. Tendonitis makes any movement of that tendon very painful and stiff.
Why & when does Achilles tendonitis happen?
Achilles tendonitis is a common injury and effects people of all ages; however it is normally seen in individuals who partake in a lot of athletic sports, in particular long distance running that involves repetitive or forceful plantar flexion of the ankle and foot. The calf muscles are made up of the gastrocnemius which originates just above the back of the knee and soleus which originates just below the back of the knee. Both muscles overlap and run down the back of the leg down to the foot and attach onto the heel (the calcaneus) via the Achilles tendon. The calf muscles are responsible for plantar flexing the foot (pointing the foot downwards) and the gastrocnemius contributes to flexing the knee. Overuse of the Achilles tendon through repetitive, high force and traumatic plantar flexion of the ankle and foot will lead to Achilles tendonitis. Typically wearing high heels for long periods of time and activities involving walking on uneven surfaces can trigger the onset.
What does Achilles tendonitis feel like?
Achilles tendonitis begins as a dull ache around the back of the ankle that gradually worsens over a course of 2-3 weeks. In some cases the discomfort is only felt on ankle plantar flexion when the Achilles tendon is stressed and with others it is felt once resting after an activity that involves ankle plantar flexion. Stiffness and dull aches are normally experienced during the night and are most intense early in the mornings. The pain and discomfort is not always restricted to the back of the ankle and often radiates up into the calf muscles of the lower leg or down into the sole of the foot. The back of the ankle and the calf muscles will be tender to touch and on occasion there may be minor swelling around the area.
How long does Achilles tendonitis take to heal?
Mild cases of Achilles tendonitis can recover in as little as 3 days to 2 weeks with treatment; whereas more moderate or chronic cases of tendonitis take much longer. However, as long as the aggravating ankle plantar flexion has been avoided during recovery most cases of Achilles tendonitis will have fully healed within six weeks. If you experience pain for longer than six weeks it is advisable to attend your GP.
How will Achilles tendonitis be diagnosed?
Your GP or therapist will be able to diagnose you by both listening to your history and examining you. No X-rays or further investigation should be needed to confirm diagnosis.
What treatment options are available for Achilles tendonitis?
Your GP will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. You will be advised to follow the R.I.C.E protocol. The R.I.C.E protocol involves resting your ankle, try not to walk about on it too much and most importantly avoid all ankle eversion movements. Ice, applying a covered ice pack to the area may also significantly hasten the healing process by reducing the pain and swelling. Please make sure the ice pack is covered to prevent any ice burn and for best results use the icepack regularly for 10-15 minutes with intervals of 30 minutes. Compression, try and keep the elastic bandage on during the day to limit the swelling and make sure to take it off at night. Elevation, keep your foot raised on cushions or a stool to help limit the swelling.
Your GP or therapist will be able to provide you with exercises to strengthen the ankle ligaments and stretch the gastrocnemius and soleus muscles to aid the healing process and prevent reoccurring injury. Many people find massage therapy helpful to loosen the affected muscles, manipulative therapies such as physiotherapy, chiropractic and osteopathy are thought to help through mobilisation treatment of the ankle, working to reduce any stiffness levels and return the joint back to its normal movement.
If your GP has mentioned or if in-fact you feel that there is some element of foot or ankle dysfunction that has predisposed you to this injury then it is very important that you see a podiatrist who can fully examine your feet and determine whether you need orthotics for your shoes. Often inappropriate and unsupportive running shoes are a factor in the development of ankle or foot tendinitis. Failure to do this may result in recurring cases of tendonitis.