Achilles tendinopathy
Achilles tendinopathy is pain, stiffness and swelling at the back of the heel and ankle, where the Achilles tendon sits. It usually comes from repetitive strain that causes small tears in the tendon. Fiona assesses the cause in an initial consultation from $100 and treats it with exercises, strapping, footwear advice and orthotics.
What Achilles tendinopathy is
The Achilles tendon is a thick band of tissue that connects the calf muscles to the heel bone. Achilles tendinopathy is a condition that causes pain, stiffness and swelling in this tendon at the back of the heel and ankle. It usually develops when repetitive strain or a sudden increase in activity puts more load on the tendon than it can cope with, which can lead to small tears in the tissue. These tears can make everyday movements painful and slow to settle.
Symptoms
The most common symptoms are felt at the back of the heel and ankle.
- Pain when walking, going up stairs or exercising
- Stiffness and swelling at the back of the ankle
- Difficulty moving the ankle joint downwards
- Tenderness over the tendon itself
- Pain that persists during daily activities
Causes and risk factors
Achilles tendinopathy is usually caused by overloading the tendon. Sudden increases in activity, running daily on hard or uneven surfaces, and training or running with poor technique can all strain the Achilles. A high-arched or flat foot type can change how much load the tendon takes. Tight calf or thigh muscles and poor footwear choices contribute as well.
Some people are more prone to it than others. It occurs more often in women than men, and age matters, as the tendon copes less well with the same activity after about 40. Carrying extra weight puts more load on the feet, ankles and lower limbs, and the Achilles is particularly susceptible to being overloaded.
Treatment at the clinic
Fiona examines your foot and ankle and ask about your activity and footwear. A biomechanical assessment, from $450 including fitting when it leads to semi-custom orthotics, or from $650 with custom orthotics, a fitting and a review appointment, can show whether your foot type or the way you walk is loading the tendon. Strapping and taping and a stretching and strengthening program can help unload the tendon while it recovers. Low level light therapy (LLLT) for tendinopathy is part of a standard consultation from $90. Fiona can arrange a heel lift or heel raise inside your shoe to take pressure off the tendon, and give footwear advice. Referral for an ultrasound or MRI can be organised when it is needed, and Fiona can refer you back to your GP if the problem needs medical management. Your GP manages any medicine, including anti-inflammatory medication.
Looking after it at home
Rest from the activities that flare the pain, and ease back in gradually. An ice pack on the sore area can help after activity. Supportive, well-fitting shoes reduce strain on the tendon, and our guide on choosing shoes may help. A regular routine of foot and calf stretches keeps the calf muscles from pulling hard on the heel. Losing weight, where that applies to you, reduces the load on the tendon. Anti-inflammatory medication is a matter for your GP or doctor, not the clinic.
When to see a podiatrist
See a podiatrist when heel or ankle pain persists for more than a few weeks, or when it changes the way you walk. Pain that stops you exercising, difficulty moving the ankle downwards, and swelling at the back of the heel are all reasons to have the tendon assessed. See your GP instead when the pain came on suddenly with a snap or pop, when the heel or calf is hot, red and very swollen, or when you cannot stand on the affected leg.
Questions
What is the difference between Achilles tendinopathy and Achilles tendonitis?
The two names are often used for the same problem, pain at the back of the heel from overuse of the Achilles tendon. Tendinopathy is the broader term for pain and change in the tendon, while tendonitis refers to the tendon being inflamed. Fiona assesses the tendon and your symptoms to work out what is going on.
How long does Achilles tendinopathy take to settle?
It varies from person to person, because it depends on how long you have had the pain, how much load the tendon is under, and what is driving it. Fiona cannot promise a recovery time. She can identify the cause and set up a treatment plan that gives the tendon the best chance to recover.
Can orthotics help Achilles tendinopathy?
Orthotics may help when the problem is biomechanical, meaning it relates to your foot type or the way you walk. Fiona assesses this first, because a foot that rolls in or a high arch can change how much load the Achilles takes. Semi-custom orthotics are from $450 including the assessment and fitting, and custom orthotics from $650 including the assessment, fitting and a review.