ACHILLES TENDINOPATHY

The Achilles tendon is a very thick tendon that connects the calf muscle on the back of the lower leg (gastrocnemius and soleus) to the heel. It bears a very large pulling force and performs plantar flexion of the foot. Acute overloading of this tendon will cause the Achilles tendon to inflame. In recent studies, prolonged overuse of the Achilles tendon will cause early degeneration of it and induce insidious pain in the heel. When suddenly overstretched, there are chances to tear or break it completely. In many cases, surgery is needed to repair the torn tissues. Well-organizing physiotherapy rehabilitation is needed to achieve full recovery.

Excessive or repetitive pulling can cause inflammation or degenerative changes of the Achilles tendon. Especially if the training intensity is too high, the training intensity increased in a short period, or training on a steep surface will cause acute or chronic inflammation due to the excessive tension in the Achilles tendon. Besides, severe Achilles tendon strains or tears are commonly associated with powerful starts of a race, jumps, sudden stops, or changing directions. Some rare conditions of calf muscle injuries are caused by direct impact.

Highly repetitive foot movements which bear weight tend to overuse the Achilles tendon excessively. The soft tissue itself will gradually grow thicker and lose flexibility. The rate of self-recovery will slow down as well. The tendon will eventually become weaker due to early degeneration and will be more susceptible to have inflammation and pain. In addition, abnormal mechanical structures of the lower limbs (such as valgus knees and flat feet) can cause the Achilles tendon to bear excessive tension.

Acute phase

• Redness, swelling, warmth, and local tender spots
• Pain in Achilles tendon when moving the ankle
• Pain increases with activity and decreases with rest

Chronic phase

• No obvious painful spots, scattered across the entire Achilles tendon and calf muscles
• When resting (e.g. sitting) for a long time or getting up in the morning, the ankle and Achilles tendon tends to feel very tight.
• Lumps or thickening of Achilles tendon
• Ankle weakness, reduced weight bearing on the affected side

The principle of treatment is to reduce the stress of the inflamed area. Other than choosing appropriate sports shoes and insoles to support the foot, ice or gentle soft tissue release also help. More stretching exercises of the calf are necessary. The gastrocnemius and soleus muscles need to be stretched separately to achieve better results. Sports taping can reduce the direct stress on the Achilles tendon, therefore, prevent re-injury.  Studies have shown that in the later stages of rehabilitation, gradual eccentric training effectively strengthens tendons and reduces the effects of tendon degeneration.

Perform calf stretching before and after the activities to prevent the Achilles tendon from over-pulling and overuse.

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