Achilles Tendinopathy: Causes, Symptoms, and Treatment Options
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on JULY 11, 2023
Have you ever experienced the frustration of being unable to participate in activities you love due to Achilles tendinopathy? This condition, which affects the Achilles tendon, can have a significant impact on your daily life, hindering your ability to run, play sports, or even walk comfortably. Understanding the causes, symptoms, and treatment options for Achilles tendinopathy is vital for early detection, prevention, and effective management.
Achilles tendinopathy goes beyond just causing pain; it can disrupt your quality of life, making it challenging to engage in physical activities and carry out routine tasks. Whether you have personally experienced Achilles tendinopathy or suspect you may be dealing with it, having in-depth knowledge about the condition is essential. Moreover, if you have friends or family members who are grappling with Achilles tendinopathy, being well-informed can help you provide better support and guidance.
This comprehensive guide is specifically designed for individuals who have encountered Achilles tendinopathy or suspect they may have it. It also extends to those seeking information to aid friends or family members who might also be suffering. By delving into the intricacies of Achilles tendinopathy, you will gain the tools and understanding needed to proactively address the condition. Let's explore the causes, symptoms, and treatment options available for Achilles tendinopathy, empowering you to regain control of your health and well-being.
What Is Achilles Tendinopathy?
Achilles Tendinopathy
The Achilles tendon is a robust and vital structure in the human body, responsible for transmitting forces between the calf muscles and the heel bone. Extensive research supports the anatomical and functional role of the Achilles tendon (Maffulli et al., 2014). Achilles tendinopathy, encompassing both tendinitis and tendinosis, has been extensively studied to understand its causes and risk factors.
Achilles tendinitis, characterized by acute inflammation of the tendon, is often attributed to repetitive stress and overuse. Research has shown that activities placing excessive strain on the tendon, such as running and jumping, can lead to tendon inflammation (Khan et al., 2012). Symptoms of Achilles tendinitis, including pain, swelling, and tenderness along the tendon, have been well-documented in various studies (Khan et al., 2012; Maffulli et al., 2014).
In contrast, Achilles tendinosis is a chronic degenerative condition resulting from overuse and repetitive microtrauma to the tendon. The breakdown of collagen fibers within the tendon is a key characteristic of tendinosis (Khan et al., 2012). Research has shown that tendinosis is primarily a degenerative condition rather than an inflammatory one, with limited signs of significant inflammation (Khan et al., 2012).
The causes of Achilles tendinopathy have been extensively studied. Overuse and repetitive strain on the Achilles tendon have been identified as common causes, leading to microtrauma and subsequent tendon damage (Khan et al., 2012). Research has also emphasized the role of sudden increases in physical activity, inadequate recovery periods, and insufficient rest as contributing factors to the development of Achilles tendinopathy (Khan et al., 2012; Maffulli et al., 2014).
Furthermore, research supports the identification of various risk factors associated with Achilles tendinopathy. Age-related changes in tendon structure and reduced blood supply have been found to increase the vulnerability to tendon injuries (Maffulli et al., 2014). Studies have also highlighted the impact of improper footwear, faulty biomechanics, and certain medical conditions such as obesity, diabetes, autoimmune disorders, and the use of fluoroquinolone antibiotics on the development of Achilles tendinopathy (Khan et al., 2012; Maffulli et al., 2014).
By incorporating the latest research into clinical practice, healthcare professionals at Keilor Road Physiotherapy can provide evidence-based care, including prevention strategies, accurate diagnoses, and effective treatment plans for individuals with Achilles tendinopathy.
If you believe you have Achilles tendinopathy, get expert ankle physio with Keilor Road Physio.
Causes and Risk Factors
Achilles tendinopathy, a condition affecting the Achilles tendon, is influenced by both causes related to overuse and individual risk factors. A comprehensive understanding of these causes and risk factors is crucial for effective prevention, early intervention, and appropriate treatment strategies.
Causes of Achilles Tendinopathy:
Overuse and Repetitive Strain: Achilles tendinopathy often develops due to repetitive stress and overuse of the Achilles tendon. Research studies have consistently demonstrated that activities involving frequent jumping, running, or sudden increases in physical activity can strain the tendon, leading to microtrauma and subsequent tendinopathy (Maffulli et al., 2014; Khan et al., 2012).
Sudden Increase in Physical Activity: Rapidly escalating the intensity, duration, or frequency of physical activity without allowing adequate time for the tendon to adapt can overload the Achilles tendon, increasing the risk of tendinopathy. Scientific evidence supports the association between abrupt changes in physical activity and the development of Achilles tendinopathy (Maffulli et al., 2014; Khan et al., 2012).
Inadequate Recovery and Rest: Insufficient rest and recovery periods between activities can place excessive stress on the Achilles tendon, hindering its ability to heal and repair. Prolonged stress without adequate rest significantly contributes to the development of tendinopathy (Khan et al., 2012).
Risk Factors for Achilles Tendinopathy:
Age: Aging is a significant risk factor for Achilles tendinopathy. Research indicates that the aging process leads to decreased blood supply to the tendon, rendering it more susceptible to injury and slower to heal. Moreover, degenerative changes within the tendon increase the risk of tendinopathy in older individuals (Maffulli et al., 2014).
Improper Footwear: Wearing footwear that lacks proper support, cushioning, or stability can increase strain on the Achilles tendon. Scientific studies have highlighted the impact of inadequate shock absorption and failure to accommodate individual biomechanical needs in the development of tendinopathy (Maffulli et al., 2014; Khan et al., 2012).
Faulty Biomechanics: Anatomical factors such as flat feet, high arches, or irregular foot alignment alter the forces transmitted through the Achilles tendon. This imbalance in load distribution increases stress on the tendon, raising the risk of tendinopathy. Multiple research studies have identified faulty biomechanics as a significant risk factor for Achilles tendinopathy (Maffulli et al., 2014; Khan et al., 2012).
Medical Conditions: Certain medical conditions, including obesity, diabetes, and autoimmune disorders, have been shown to impair tendon healing and increase susceptibility to Achilles tendinopathy. Additionally, the use of fluoroquinolone antibiotics has been associated with an elevated risk of tendon-related problems (Maffulli et al., 2014).
By recognizing these causes and risk factors, individuals can take proactive measures to reduce the likelihood of developing Achilles tendinopathy. Implementing appropriate modifications in activity levels, ensuring adequate rest and recovery, using proper footwear, and addressing underlying biomechanical issues through targeted interventions are evidence-based approaches to minimize the risk of Achilles tendinopathy.
Recognizing Achilles Tendinopathy
Recognizing the signs and symptoms of Achilles tendinopathy is essential for early detection and effective management. Understanding these indicators allows individuals to seek timely medical attention and implement appropriate interventions to promote recovery and prevent further complications. At Keilor Road Physiotherapy, we rely on evidence-based practices to provide valuable insights into recognizing Achilles tendinopathy.
Signs and Symptoms:
Pain: Achilles tendinopathy is typically characterized by pain along the midportion of the Achilles tendon, where it attaches to the heel bone (calcaneus). The pain may be experienced as a dull ache, stiffness, or sharp discomfort. It often worsens with activity and may be more pronounced in the morning or following periods of rest (Kearney et al., 2020).
Swelling: Swelling or thickening of the Achilles tendon may be observed in cases of tendinopathy. This can be accompanied by localized warmth or redness (Maffulli et al., 2019).
Stiffness: Individuals with Achilles tendinopathy may experience stiffness in the affected area, particularly upon waking up or after prolonged periods of inactivity. This stiffness often improves with movement and gentle stretching (Martin et al., 2020).
Tenderness: The Achilles tendon may be tender to the touch, with localized areas of increased sensitivity or pain along its length. Palpation along the tendon can elicit pain and reveal areas of tenderness (Kongsgaard et al., 2009).
When to Seek Medical Attention:
It is important to consult a healthcare professional if you experience the following scenarios:
Severe Pain or Sudden Onset: If you experience intense or sudden onset of pain in the Achilles tendon, particularly after a traumatic injury or activity, seek immediate medical attention to rule out a more severe condition, such as a tendon rupture (Molloy et al., 2020).
Difficulty Walking: If your Achilles tendinopathy causes significant discomfort or hampers your ability to walk or bear weight, consult a healthcare provider for assessment and appropriate management. Difficulty walking may indicate a more advanced stage of tendinopathy that requires intervention (de Jonge et al., 2011).
Self-Assessment Techniques:
While self-assessment cannot replace a professional diagnosis, individuals can use certain techniques to gauge the severity of Achilles tendinopathy. These include:
Pain Scale: Assessing pain levels on a scale of 0 to 10 before and after activity can help monitor symptom progression and evaluate the effectiveness of treatment (Murphy et al., 2019).
Functional Limitations: Assessing the impact of Achilles tendinopathy on daily activities, such as walking, running, or climbing stairs, can provide insight into its severity. Monitoring any limitations in range of motion or functional activities can guide treatment decisions (van der Plas et al., 2012).
Palpation: Gently palpating the midportion of the Achilles tendon to identify areas of tenderness or swelling can assist in understanding the extent of the condition. This can provide additional information for healthcare professionals during the assessment process (Alfredson et al., 1998).
If you suspect Achilles tendinopathy based on the signs and symptoms described, it is advisable to consult a qualified healthcare professional for a comprehensive assessment and personalized treatment plan. The physiotherapists at Keilor Road Physiotherapy can provide a thorough evaluation, accurate diagnosis, and appropriate interventions to address Achilles tendinopathy effectively, based on the latest evidence and clinical expertise.
Diagnosing Achilles Tendinopathy
Diagnosing Achilles tendinopathy requires a comprehensive approach that includes physical examinations, assessment of medical history, and, when necessary, imaging tests. Research supports these diagnostic methods as effective means of accurately identifying Achilles tendinopathy. At Keilor Road Physiotherapy, we emphasize the importance of consulting a healthcare professional for an accurate diagnosis.
Physical Examinations:
Physical examinations play a crucial role in diagnosing Achilles tendinopathy. Research has shown that palpation of the Achilles tendon, evaluating for tenderness, swelling, and thickening, is a reliable method for assessing the condition (Maffulli et al., 2014). Additionally, range of motion and strength tests provide valuable information about the function and integrity of the lower limb (Silbernagel et al., 2007). These examinations help differentiate Achilles tendinopathy from other musculoskeletal conditions and guide appropriate treatment planning.
Assessment of Medical History:
Thorough assessment of an individual's medical history is essential for diagnosing Achilles tendinopathy. Research suggests that understanding the onset, duration, and progression of symptoms, as well as previous injuries or medical conditions, aids in accurate diagnosis and management (Khan et al., 2012). Factors such as activity level, footwear, training techniques, and prior treatments provide valuable insights into the underlying causes and contributing factors of Achilles tendinopathy.
Imaging Tests:
In some cases, imaging tests such as ultrasound and magnetic resonance imaging (MRI) may be necessary to confirm the diagnosis of Achilles tendinopathy. Research supports the use of ultrasound as a reliable tool for visualizing tendon structure, detecting degeneration, and assessing neovascularization, a common finding in tendinopathy (Khan et al., 2012). MRI can also provide detailed information about tendon abnormalities and assist in differentiating tendinopathy from other tendon disorders (Maffulli et al., 2014).
Consulting a Healthcare Professional:
Consulting a healthcare professional, particularly a physiotherapist with expertise in musculoskeletal conditions, is vital for an accurate diagnosis of Achilles tendinopathy. Research highlights the importance of a comprehensive assessment conducted by a skilled professional to determine the presence and severity of tendinopathy (Khan et al., 2012). Keilor Road Physiotherapy are experts in interpreting clinical findings, ordering appropriate imaging tests if necessary, and developing personalized treatment plans based on evidence-based practices.
By seeking professional guidance from a physiotherapist at Keilor Road Physiotherapy, individuals with suspected Achilles tendinopathy can ensure a precise diagnosis and receive appropriate interventions supported by research. Early and accurate diagnosis is crucial for initiating timely treatment and optimizing outcomes in managing Achilles tendinopathy.
Treatment Options for Achilles Tendinopathy
Achilles Tendinopathy treatment
Achilles tendinopathy requires a comprehensive treatment approach that addresses pain relief, tissue healing, and functional restoration. As research continues to advance, new management strategies are emerging, offering improved outcomes for individuals with this condition. It is crucial to consider contemporary research and evidence-based practices when developing a treatment plan tailored to the individual's needs and the severity of Achilles tendinopathy.
Load Management: Recent studies highlight the importance of load management as a key component of Achilles tendinopathy treatment. This approach involves modifying the amount and type of physical activity to ensure optimal tendon healing and prevent excessive stress. Gradual progression of load, guided by pain and symptom response, has been shown to be effective in reducing pain and improving function (Rio et al., 2016; Beyer et al., 2015).
Exercise-Based Rehabilitation: Eccentric exercise programs have long been a cornerstone of Achilles tendinopathy treatment. However, contemporary research suggests that a combination of eccentric and concentric exercises, known as "heavy slow resistance" training, may yield superior outcomes. This approach focuses on slow, controlled movements with heavier loads, promoting tendon remodeling and improved strength (Rio et al., 2016; Malliaras et al., 2018).
Biomechanical Assessment and Correction: Addressing underlying biomechanical factors can contribute to successful management of Achilles tendinopathy. Biomechanical assessments, including gait analysis and foot posture evaluation, can identify factors such as excessive pronation or inadequate muscle control that may contribute to tendon overload. Custom orthotic devices and targeted strengthening exercises can help correct these imbalances and alleviate tendon stress (Rio et al., 2016; Reiman et al., 2014).
Novel Therapies: Emerging treatment modalities, such as extracorporeal shockwave therapy (ESWT), platelet-rich plasma (PRP) injections, and ultrasound-guided percutaneous needle tenotomy (PNT), show promise in the management of Achilles tendinopathy. ESWT delivers high-energy shockwaves to the affected area, promoting tissue healing and reducing pain. PRP injections involve injecting concentrated platelets from the patient's blood into the tendon, stimulating healing processes. PNT involves using a specialized needle to break down scar tissue and promote tendon regeneration (Gross et al., 2016; Martinelli et al., 2019).
Psychological Interventions: Addressing psychological factors, such as fear of movement or pain catastrophizing, has gained recognition in Achilles tendinopathy management. Incorporating cognitive-behavioral strategies, education, and goal-setting can help individuals develop a positive mindset and overcome barriers to recovery (Scott et al., 2021; Rathleff et al., 2020).
It is important to note that the treatment approach should be individualized based on the specific needs and goals of each person with Achilles tendinopathy. Consulting with a qualified healthcare professional is crucial to receive the most up-to-date and evidence-based treatment options. At Keilor Road Physiotherapy we strive to integrate contemporary research and management strategies into the treatment plan, allowing individuals to achieve optimal outcomes, including reduced pain, improved function, and a successful return to activities.
Preventing Achilles Tendinopathy
Preventing Achilles tendinopathy is crucial for individuals who aim to maintain optimal lower limb health and minimize the risk of developing this condition.
Dynamic Warm-up: Engaging in a dynamic warm-up routine that includes specific exercises targeting the lower limbs has shown to be beneficial in reducing the risk of Achilles tendinopathy. Research suggests that dynamic stretching and activation exercises, such as high knees, leg swings, and calf raises, can enhance tendon flexibility and increase blood flow to the Achilles tendon (Lauersen et al., 2013).
Gradual Load Progression: Gradually increasing the load on the Achilles tendon is essential to allow the tendon to adapt and strengthen over time. The use of a systematic and progressive training program, incorporating appropriate rest days and monitoring for any signs of pain or discomfort, can help prevent excessive strain on the tendon (Silbernagel et al., 2007).
Footwear Selection: Choosing footwear that provides adequate support, cushioning, and stability is crucial in preventing Achilles tendinopathy. Recent studies have highlighted the importance of footwear characteristics, such as a slightly elevated heel, appropriate arch support, and cushioning in the midsole, to reduce stress on the Achilles tendon during physical activities (Ryan et al., 2014).
Eccentric Exercises: Incorporating eccentric exercises for the calf muscles has shown promising results in preventing and managing Achilles tendinopathy. Eccentric exercises involve lengthening the muscle while it is under tension, which has been found to promote tendon remodeling and improve tendon strength and resilience (Alfredson et al., 1998).
Biomechanical Analysis: Conducting a thorough biomechanical analysis can identify any abnormalities or imbalances that may contribute to Achilles tendinopathy. Addressing underlying issues, such as poor foot alignment, muscle imbalances, or faulty running mechanics, through individualized corrective exercises and orthotic interventions can help reduce the risk of tendon overload (Lopes et al., 2020).
Cross-Training and Periodization: Incorporating cross-training activities and implementing periodization in training programs can minimize the repetitive stress on the Achilles tendon. Alternating between different types of exercises and varying the intensity and duration of training sessions can allow for proper recovery and reduce the risk of overuse injuries (Silbernagel et al., 2015).
By implementing these contemporary research-based prevention strategies, individuals can proactively protect their Achilles tendon and minimize the risk of developing Achilles tendinopathy. Emphasizing dynamic warm-up routines, gradual load progression, proper footwear selection, eccentric exercises, addressing biomechanical factors, and incorporating cross-training and periodization can significantly contribute to maintaining optimal lower limb health and preventing Achilles tendinopathy.
Conclusion
Achilles tendinopathy is a prevalent condition that affects a substantial portion of the population. Research studies have indicated that approximately 9% to 11% of adults will experience Achilles tendinopathy at some point in their lives (Maffulli et al., 2019; Sayana & Maffulli, 2014). By gaining a comprehensive understanding of the condition, seeking professional guidance, and adhering to individualized treatment plans, individuals can effectively manage and overcome Achilles tendinopathy. With dedication and proper care, it is possible to regain mobility, return to the activities you love, and lead an active life.
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Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.