The Achilles tendon is the largest tendon in the human body. It forms the attachment between the heel bone and the calf muscle. Injury to the tendon may cause it to become inflamed or torn.
Achilles tendonitis refers to the inflammation of the Achilles tendon. A tear of the tendon is referred to as a rupture.
Why does it occur?
There are a number of reasons why Achilles tendonitis may occur:
• Tightness in the calf muscles
• Tightness in the achilles tendon
• Overuse of the achilles tendon
• A change/increase in the intensity of exercise or a change in footwear
• Uphill running
• Wearing of heels during the day and flat runners for exercise
• Over-pronation –when the feet roll in and flatten more than normal when you run and walk.
Achilles tendon tears on the other hand occur during sudden activities e.g.) jumping, starting of running.
In the case of Achilles tendonitis pain is normally localized over the tendon. Pain will occur when rising up onto your toes and also during stretching of the tendon. In most cases there is mild pain after exercise or running that gradually increases. Often the calf feels sluggish and there may also be stiffness at the ankle that usually decreases as the tendon warms up. Also common is morning tenderness and there may also be swelling evident over the tendon.
There may also be episodes of diffuse or localized pain along the tendon a few hours after exercise.
In the case of a tendon tear or rupture a pop may be felt. If a complete tear has occurred you will be unable to lift your heel of the ground.
Your physiotherapist will be able to assess you for Achilles tendonitis. They will assess which are the most likely causative factors and address those in the treatment. Generally treatment will consist of electrotherapy modalities to aid in decreasing the inflammatory process and aid in healing. Treatment would also typically consist of manual therapy techniques specifically addressing the individual patient problems. Your physiotherapist will also prescribe exercises for strengthening and stretching and educate you on things such as return to sport and prevention of further injury. A referral to a podiatrist may also be required to provide orthotics in the case of over-pronation being a major cause of the tendonitis.
In the case of a tear or rupture of the Achilles tendon surgery may required as well as a period of immobilization in a cast. Following removal of the cast your physiotherapist will be able to help in your rehabilitation and return to sport /exercise as well as prevention of re-injury.