Achilles tendon pain

Background

The old term for this disorder was ‘Achilles Tendonitis’. The ‘itis’ at the end refers to inflammation which, despite the tendon being enlarged and tender, is not present. In fact it is this the lack of inflammation  why this disorder takes so long to recover.

 

What causes it?

The Achilles tendon (and all leg tissues) is constantly stressed when walking and running. Our bodies are constantly repairing this damage. Tissues become more damaged with increasing age and load placed upon it. When the rate of damage exceeds the rate of repair the tissue becomes permanently injured and painful. The commonest causes include being overweight, spending long periods on your feet or sports (particularly running). Occasionally, no cause is obvious.

 

What happens with no treatment?

Even if nothing is done medically the pain will settle. It does so very slowly however. Most people (80%) are better within 6 months; 90% by 1 year and 95% by 18 months. The following treatments aim to shorten this timescale.

 

Treatment options

 •The most important point is for you to identify a cause in your lifestyle that may be contributing and correct this if possible.

•Other simple options also include wearing cushioned shoes (e.g. trainers) and having frequent rests from long periods of standing.

•A particular type of stretching exercises called ‘eccentric training exercises’ are the most beneficial (proven in studies). These exercises can be performed at home using a step (under the supervision of a physiotherapist). The tendon is stretched in a controlled way under the power of  the calf muscles. 

•Injections of steroid into the painful area are not indicated as it can lead to a rupture of the tendon.

•Insoles from a podiatrist have very little benefit other than gel-filled heel cups to cushion (available at chemists). Distance runners may benefit from insoles.

•High frequency shockwave ultrasound is a newer technique which has shown to be effective in some patients if stretching fails to help. There are no complications (apart from some minor discomfort during the treatment).

•Surgery is performed if all simple procedures fail to control pain and consists of excising (removing) the abnormal tendon. A 2 week period in a temporary cast is followed by progressive return to normal function. Good pain relief in 80% of patients are usual within 3 months of surgery.

 

Achilles stretching and strengthening - 'eccentric' exercises

Eccentric 1eccentric2