Just above the heel of your foot is a thick band of tissue called the Achilles tendon. It is the largest tendon in the body and runs from your calf muscles (gastrocnemius and soleus muscles) to the heel bone (calcaneus). It is important because it helps you lift your heel off the floor during walking. It can also help you to run, stand and go up onto tiptoes. When the tendon gets inflamed and causes pain it is labelled “Achilles tendonitis”. It is an overuse injury that is common in joggers and jumpers, due to the repetitive action.
I see this condition often in clinic, particularly in spring time when patients decide they want to get fit for the summer and increase their fitness levels and are possibly training too hard too quickly. I commonly see this in individuals whose work puts stress on their ankles and feet, such as labourers, as well as in “weekend warriors”—those who are less conditioned and participate in athletics only on weekends. This repetitive movement of the ankle places stress through the Achilles and can cause it to get inflamed.
Causes of Achilles tendinitis
· Overuse injury – Athletes who over-train are at a higher risk of developing disorders of the Achilles tendon. Runners seem to be the most susceptible. People who play sports that involve jumping, such as basketball, are also at increased risk
· Foot Problems – People with excessive pronation (flattening of the arch) have a tendency to develop Achilles tendinitis and tendonosis due to the greater demands placed on the tendon when walking. The flattened arch pulls on calf muscles and keeps the Achilles tendon under tight strain. This constant mechanical stress on the heel and tendon can cause inflammation, pain and swelling of the tendon. Being overweight can make the problem worse
· Arthritis – Achilles tendonitis can be a part of generalised inflammatory arthritis, such as psoriatic arthritis or ankylosing spondylitis. In these conditions, both tendons can be affected. Tendinitis from arthritis is more common in middle-aged and older adults. A bone spur or growth may form in the back of the heel bone. This may irritate the Achilles tendon and cause pain and swelling
· Footwear – Poor-fitting footwear can place more stress and instability through the feet when walking or running and can increase the risk. If heels are regularly worn this will result in the Achilles tendon shortening, then when flat shoes are worn for exercises, stress will be placed on the tendon resulting in injury
· Tight hamstring (back of the thigh) and calf muscles
· Excess weight and obesity – being overweight places more strain on many parts of the body, including the Achilles tendon. The best evidence available to date indicates that obesity is a risk factor for tendinopathy – http://bit.ly/209AabL
Signs and symptoms
- Most common complaint is sharp or dull pain focal to the back of the ankle and/or lower leg, usually close to the heel
- Usually pain is worse first thing in the morning as weight is put through the foot
- People may experience tenderness, redness and warmth over the affected area
- A reduction in movement of the ankle
- Pain and stiffness after periods of disuse of the calf muscles (e.g. from prolonged sitting and after sleeping)
- Inflammation and pain after overuse of the calf muscles (e.g. post walking, running, jumping)
Osteopathic treatment and management
- Your osteopath will perform a detailed past medical history and perform a physical examination to determine the extent of the injury and treatment approach
- We will examine your back, pelvis, legs and the rest of the body to ensure that the walking/running cycle is not influencing your feet and ankles in an abnormal way
- Soft tissue massage of lower leg muscles
- Joint mobilisation
- Deep friction techniques into the Achilles tendon
- Ultrasound therapy
- Reduce the level or completely avoid activities (e.g. running that aggravates the condition)
- The osteopath may insert a heel lift into shoes for the duration of the injury if patients over-pronate or have gait abnormalities
- The osteopath may recommend you see your GP or a pharmacist to prescribing a course of nonsteroidal anti-inflammatory drugs (NSAIDS) to help to reduce the inflammation
- Ice regularly after activities you know aggravate it and cannot avoid. It is of great benefit in the first 24-48 hours
- Immobilisation – Depending of the severity of the injury, you may need to be referred so your foot can be placed in a cast or boot to limit movement of the ankle, to reduce forces through the Achilles tendon and promote healing
- If further investigation is required, we may refer you for tests that may include an x-ray of the foot, ultrasound and occasionally blood tests (to test for an inflammatory condition), and an MRI scan of the tendon.
- As the tendinitis improves, introduce strengthening and stretching exercises to assist in restoring the ankle back to its “normal” state and improving the strength to avoid the injury from reoccurring
- Advice on wearing better, more supportive footwear to reduce the stress and instability through the foot
The treatment and management approach will be selected on the basis of how long the injury has been present and the degree of damage to the tendon. It is imperative that you look after your feet and ankles. They keep you moving and give you the ability to do and experience wonderful things. Take care of them!