Understanding Achilles Tendonitis
Achilles tendonitis is a common injury associated with the presence of inflammation and scar tissue of the largest tendon in the body. The Achilles tendon is located above the ankle in the back of the lower leg. It connects the large calf muscles (Gastrocnemius and Soleus) to the heel bone (calcaneus). Its main function is to transfer power to the ankle during the push off phase of the gait cycle while both walking and running.
Achilles tendonitis is commonly described in the literature as Achilles tendinopathy. The presence of scar tissue and degenerative changes of the tendonous tissue often accompanies the inflammation. A decrease in the elastic qualities and a reduction of the tendon fiber strength is a common finding with athletes older than 30 years of age with Achilles tendonitis.
Achilles tendonitis can be either acute, meaning occurring over a period of a few days, or chronic, which occurs over a longer period of time.
The location of the inflamed tissue can be anywhere along the tendon form the calf muscle or where it attaches to the heel bone or calcaneous bone. Because of the daily stresses place on that area of your body during a normal day of walking and being active and a less than adequate blood supply, the healing of the Achilles tendon is often slow.
Expanding on what was stated earlier, it’s important to understand that the two muscle of the “calf” merge together to form the Achilles tendon before it anchors or inserts into the calcaneus bone. The Gastrocnemius in the larger and more superficial muscle and it originates above the knee. The Soleus is the deeper and shorter muscle that does not cross over the knee joint.
Therefore, whenever Achilles heel pain is being treated, the two calf muscles need to be involved if long-term pain control is the objective.
Signs & Symptoms of Achilles Tendon Pain
- With milder cases of Achilles heel pain, the localized pain in the Achilles at the beginning of exercise will decreases as the athlete warms-up.
- The onset of pain can be as fast as within minutes or a gradual increase in symptoms over a period of days or weeks.
- Symptoms such as pain, stiffness and calf weakness typically decrease with rest.
- Tenderness noted anywhere along the tendon with palpation and with activities.
- Prolonged period of inactivity such as in the mornings or after sitting for a long period of time will result in significant Achilles tendon pain and stiffness.
- Palpable knots or lumps in the Achilles tendon are common.
- Tendon “squeaking” can often be felt with ankle motion.
- When performing a one-legged toe raise with the knee completely straight, pain in the tendon, weakness in the calf and limited range of motion in the ankle is demonstrated.
- Swelling or thickening within the tendinous sheath is common.
Causes of Achilles Heel Pain
Achilles tendonitis is typically an overuse injury. The basic cause of an overuse injury is when a person does “too much to soon”. With that being said, other factors can contribute to inflammation of the largest tendon in the human body:
- Altered or improper footwear for both activities and work environments.
- Changes in training surface firmness and inclines such as hills.
- Rapid increase in activity volume and/or intensity.
- Insufficient recovery time between workouts.
- Various arch and foot pathologies such as fallen arches, excessive pronation, hyper-supination or poor toe alignment.
- Weak calf muscles
- Tight calves and Achilles tendons
- Stiff ankles due to arthritic changes.
Professional Treatment for Achilles Tendon Pain
- Avoid the activities and footwear that are linked to the symptoms. These two issues are classic factors with Achilles tendonitis.
- Place a ¼ – ½ inch heel lift in both shoes whenever walking more than 50 yards.
- Avoid prolonged barefoot walking.
- Massage of calves, arches and front of ankles to promote a decrease in Achilles tendon and ankle stress with motion.
- Improve arch and toe flexor strength with activities such as marble or rock pickups and towel curls in a seated position.
- Perform daily calf rolling treatments for the calf and peroneal tendons (lower outside of the shin) but not on the Achilles tendon itself is a beneficial way to promote the healing of Achilles tendonitis. The most effective technique is to warm up the tissue prior to treatment and while slowly rolling the areas noted above, slowly breath comfortably while consistently moving the foot in a large circular pattern.
- When at least 75% of the pain is eliminated with walking, initiate toe raises to strengthen the calf muscles. Start with double legs on a flat surface and progress to single legs on an uphill incline. Between strengthening sets, perform a 20 second “duck walk” which is a straight legged walking technique on the heels with the front of the foot off the ground. This crazy looking exercise an effective drill that I like to use to both enhance the strength in the front of the ankle and prolong the stretching of the Achilles tendon and calf.
- Stretching of the two calf muscles is important for long-term reduction of Achilles tendon pain. Wall pushes or slant-board stretches should be performed with both the knees straight and the legs bent to address both muscles and the Achilles tendon. Key Tip – Adjust the angle of your foot to keep the stretch pain-free while performing five (5) slow breaths to promote a relaxed elongation of all the tissue being stretched.
- Compression of the calf during activities to maintain warmth and improve blood flow.
- Ice your Achilles tendon and calf muscles in a moderately stretched position. Ice bags/veggie, ice cup or ice bucket will work.
Questions a Pro Athlete Would Ask
A smart professional athlete with Achilles Tendonitis who wants to safely return to his/her sport will ask his sports medicine specialist the following questions:
- What are the main factors to why I have Achilles tendon pain?
- Do I have abnormal foot/arch/subtalar joint biomechanics that need to be addressed with an orthotic?
- Do I have a leg length difference of greater than 1/4 inch?
- Am I a candidate for a cross friction massage on my Achilles tendon or will that form of treatment be too aggressive?
- Who is the best physical therapist in this area to rehab with for my Achilles heel pain?
Elite Sports Medicine Tips
- Look Around – This Achilles tendon pain is probably more a result of somethingelse than just an isolated inflammatory issue with your tendon. Look at everything from your shoulder levels to your core strength to your ugly toes for clues.
- Why Now? – What triggered the flare-up now, Detective? List the activities and factors that you changed in the last month and you may be shock to see the reason(s) looking right at you!
- Rubberband Man NOT – I watch my young son stretch and bend like Stretch Armstrong. We are probably not as flexible as we need to be so do something every day to stretch your shoulder, back and legs.
- Check Your Sole – Compare the wear pattern on your favorite shoes. Do the soles look different from one side to the other?
- Avoid Hills…For Now – As you return to your activities avoid hills for the first couple of weeks. Whether running, walking or on a bike, hills will apply excess stress on the calves and Achilles tendon.