Achilles Tendinopathy

Achilles tendinopathy is a common overuse injury that occurs as a result of repetitive energy storage and release in excess of what the tissue is capable of. Similar to plantar fasciopathy, it usually occurs when there is a sudden increase in activity.

The theory that health care professionals are guided by is that the initial stages of a tendinopathy is the reactive phase, where there is mild swelling within the tendon in attempt for it to adapt to the new stresses put through the tissue. With activity modification and relative rest these symptoms can settle and can resolve relatively quickly. However if the tendon continues to be loaded excessively, then it progresses onto tendon disrepair and then a degenerative tenon, where there is increased collagen disruption and increased symptoms

Achilles tendinopathy can be described as insertional, where the tendon blends into the heel bone, or ‘mid-portion’ where there is pain located in the middle part of the tendon.

People may be able to recall the start of symptoms following prolonged activity that they are not used to doing, such as starting a new fitness regime etc. Typically people will report:

• Morning Pain
  
• Calf tightness / stiffness
  
• There may be a palpable and painful lump within the tendon
  
• Initial pain when performing activity but settles as the tendon becomes ‘warmer’

A thorough objective assessment would likely identify:

• Reduced range of motion, particularly when bringing toes towards you
  
• Palpation – calf tightness may be evident but also pain when pressing the tendon.
  
• A positive arc sign
  
• Increased / decreased arch on the inside of the foot
  
• Limp may be evident
  
• Reduced strength

• Advice and education
  
• Activity modification 
  
• Biomechanical assessment
  
• Progressive strength exercise programme
  
• Stretching
  
• Manual therapy
  
• Taping