Achilles Tendinopathy

What is Achilles Tendinopathy?

The Achilles tendon stems from the gastrocnemius and soleus muscle in the calf and attaches into the heel bone. It is a tough band of fibrous tissue that has the ability to resist large forces and loads.

Achilles tendinopathy can be either mid-portion or insertional depending on the location. Mid-portion refers to the tendon body itself. Insertional refers to the site where the tendon attaches to the bone.

Achilles tendinopathy follows a continuum of three stages – ‘reactive tendinopathy’, ‘tendon disrepair’ and ‘degenerative tendinopathy’. The state of the tendon can move along this continuum through managing the amount of load on the tendon.

Achilles tendon pain often tends to be worse on first steps in the morning, or after a period of rest. It can then ease off as you ‘warm up’ into an activity, for example walking or running. You may notice some redness and thickening of the achilles tendon, and pain tends to be localised to the site of the tendon.

What causes Achilles tendinopathy?

Achilles tendinopathy occurs when the tendon is overloaded, for example by a sudden increase in the amount or intensity of activity you are doing. When this happens, the tendon has exceeded its load tolerance capacity, and can’t cope with the demands of this increase or change in activity, therefore causing pain. This is known as ‘reactive tendinopathy’. If the amount of load placed on the tendon in this stage isn’t managed appropriately, it can progress to ‘tendon disrepair’ through continued overloading of the tendon, and the tendinopathy can become chronic.

How can physiotherapy help?

At Physiotherapy Matters, our physiotherapists can conduct a thorough assessment to confirm the diagnosis, help you manage pain and return to normal activity.

Treatments which help Achilles tendinopathy include:

• Home exercises – your physiotherapist will give you an exercise programme based around progressive loading of the tendon. This improves the strength of the tendon and its ability to absorb load, helping you to get back to the activities you love.
• Taping – use of kinesiology tape can help to provide some support to the tendon and calf and provide some symptom relief.
• Heel inserts – these can help to offload the achilles tendon, helping to manage pain and loading in the initial stages.
• Shockwave therapy – this has been shown to be an effective treatment for chronic tendinopathy. See our page on shockwave therapy for more information on this.
• Soft tissue massage – massage to the muscles around the achilles tendon such as the calf muscles and the plantar fascia (which runs along the sole of the foot) can help to reduce any muscular tightness which may be contributing to your symptoms.