Achilles tendinopathy
Achilles tendinosis / Achilles tendinitis

The Achilles tendon is located at the back of the calf and attaches to the heel. In Achilles tendinopathy, the problem is located in the tendon itself or in its attachment to the heel bone.

The Achilles tendon connects the calf muscle (the triceps surae) to the heel bone. It is the strongest tendon in the body. This is a good thing, because the tendon experiences significant forces during walking, running, going up and down steps and jumping.

Description of condition

In Achilles tendinopathy, the quality and structure of the tendon are reduced (tendinosis) or the tendon is inflamed (tendinitis). A distinction is made between tendinopathy of the mid-section of the tendon and tendinopathy affecting the attachment of the tendon to the heel bone. If the mid-section of the tendon is affected, the symptoms clear more quickly than when the problem is located at the attachment site.

If the symptoms are located higher up the back of the lower leg, this may indicate a torn calf muscle.

Cause and history

The symptoms generally occur gradually once the tendon has been strained for an extended period. This does not have to involve a heavy burden. Runners in particular have an increased risk of developing this Achilles tendon injury.

Other factors that may contribute to the symptoms developing include: increasing training intensity, change of footwear, the foot turning inward (overpronation), weakness of the calf muscle or a shortened calf muscle.

In severe cases the tendon may even tear. This is referred to as an Achilles tendon rupture. A rupture will only occur in a healthy tendon if it endures extreme (tractive) forces. If tendinosis is present, the tendon can also rupture with more gentle activities.

Signs & symptoms

• Painful Achilles tendon or tendon attachment to the heel bone.
  
• In the early stages the symptoms occur primarily after exercise. Later on the symptoms can also occur during exercise or even be present continuously at rest.
  
• Pain when standing on your toes, jumping or hopping.
  
• The tendon may be slightly swollen.
  
• Direct pressure on the tendon or attachment site is painful.

Diagnosis

Treatment

The causative factors will be determined and treated. Physiotherapy treatment consists of eccentric exercises for the Achilles tendon and stretching exercises. Approximately 60 - 90% of patients with tendinopathy of the mid-section of the Achilles tendon benefit from this treatment and are symptom-free within 12 weeks if the correct exercise program is followed. If the attachment site of the tendon is affected, the patient needs to realize that the symptoms will likely persist for a longer period.

Exercises

Follow this exercise program with specific exercises for Achilles tendinopathy.

You can check your symptoms using the online physiotherapy check or make an appointment with a physiotherapy practice in your locality.

References
Alfredson, H. & Cook, J. (2006). Pain in the achilles region. In: Brukner, P., Kahn, K., eds. Clinical Sports Medicine. Sydney, Australia: McGraw-Hill; 2006:590-611.
Nugteren, K. van & Winkel, D. (2008). Onderzoek en behandeling van spieraandoeningen en kuitpijn. Houten: Bohn Stafleu van Loghum.