Achilles Tendinitis

The Achilles tendon is the thickest and strongest tendon in the body.

Overuse injuries of the Achilles tendon used to be referred to as Achilles Tendinitis. The correct term for this condition is Achilles Tendinopathy due to the lack of inflammatory cells in the injured tendon.

Most of our patient’s refer to the condition as Achilles tendinitis so we will refer to it as that on this page.

Symptoms of Achilles Tendinitis

Most people complain of a gradual onset of symptoms. Some common Achilles Tendinitis / Tendinopathy symptoms include:

  • Morning pain or stiffness felt over the Achilles Tendon. Usually worse after a long run or intense training session.
  • Pain that decreases gradually with walking or when applying heat on the tendon. Eg. a warm shower.

  • Swelling or thickening or nodules in the tendon

  • Crepitus or a “crackling” feeling over the tendon

Achilles Tendinitis is either classified as midportion or insertional depending on where the pain is located in the tendon.

In midportion Achilles tendinitis you would feel pain and stiffness about 1-2cm above the calcaneus (heel bone).

People with insertional Achilles tendinitis feel pain and stiffness right at the point where their Achilles tendon attaches to the calcaneus.

nike running shoes with a low heel drop

Causes of Achilles Tendinitis

Studies have found that runners have a 15x greater risk of Achilles Tendon disorders due to the high loads that the tendon is required to absorb with each foot strike.

There are a number of physical causes that can contribute to overuse injuries of the Achilles tendon:

  • Increased running distance, speed or gradient.

  • Decreased recovery time between training sessions.

  • Reduced ankle mobility, specifically the Talocrural and Subtalar joints.

  • Tight or weak calves.

  • Excessive pronation from foot strike to midstance causing a “whipping” action of the achilles tendon.

  • Transitioning from running shoes with a high heel drop to a low heel drop.

  • Poor quality or worn out running shoes.

Treatment of Achilles Tendinitis

A thorough history taking is necessary to help us identify any risk factors such as sudden increases in training intensity, volume or shoe changes that could be linked to the onset of your symptoms.

A physical assessment will then be performed looking at the range of motion of your ankles, knees and hips. There are a number of strength and hopping tests that can also be used to help identify any weak muscle groups along the kinematic chain.

Referral for Ultrasound or MRI scans can be coordinated with your GP if needed. For most cases of Achilles tendinopathy/tendinitis, we can begin treatment and rehabilitation without the need for imaging based on your history and physical assessment. Midportion Achilles tendinopathy usually has a better prognosis compared to insertional tendinopathy.

We use a combination of manual therapies such as mobilisation of the ankles and hips. Myofascial release, dry needling and trigger point therapy is used to release tight muscles of the leg. Extracorporeal Shockwave Therapy is another highly effective tool that we use to reduce pain and to promote the release of growth factors in the tendon. Research has found that the best results are achieved by using a combination of Shockwave Therapy and rehabilitation exercise compared to using just one of the other on their own. You can learn more about Shockwave Therapy by clicking here.

Taping techniques can also help control pain. Our favourite is a product called Dynamic tape. It is a highly elastic tape that is used to offload some of the strain that the Achilles Tendon has to deal with.

Dynamic tape achilles achilles tendinopathy

Let Us Help With Your Achilles Tendon Pain

Achilles Tendinitis Rehabilitation

Studies have found that eccentric (negative) calf raises or heel drops are an effective exercise to promote the recovery of the Achilles tendon. A rehabilitation program of heel drops was found to be more effective than heel raises.

Specific stretches, mobility and stability exercises will be prescribed to help correct any abnormal biomechanics in the kinematic chain from the spine down to the foot.

plantar fasciitis rehabilitation exercise