Achilles Tendinopathy
The Achilles tendon is the strongest and largest tendon in the body. It is made up of the soleus and gastrocnemius muscles (calf muscle) and attaches to the posterior calcaneus (heel bone).
The Achilles tendon can become damaged and irritated through overuse, repetitive stress, or sudden increases in activity. This can lead to the condition known as Achilles tendinopathy/tendinitis.
Tendinopathy is the chronic (later stage) of tendonitis (acute or initial pain stage).
Tendonitis often appears first while tendinopathy occurs with chronic inflammation of this area. Often, tendinopathy is characterized by a thickened insertion of the Achilles tendon in a patient with a history of Achilles tendonitis.
Treatment Plan
- Rest/Activity Modification: Reducing or modifying activities that worsen pain (such as running, jumping, or walking up stairs/hills)
- Stretching: Stretching the calf muscles is a primary component of treatment. Equinus (tight calves) often contribute to Achilles pain.
- Eccentric Strengthening/Stretching: Exercises that focus on dorsiflexing the foot (toes to nose).
- Orthotics/Heel Lifts: Heel lifts are often first line treatment options to plantar flex (toes down) the foot and relieve pressure from the Achilles insertion.
- NSAIDs/Injections: Short-term use of NSAIDs can help manage pain. Low dose steroids, but a high volume, injection into Kager’s triangle (an area in from of the Achilles, is utilized to provide faster relief. It should be noted, the Achilles tendon itself should never be injected as steroids can lead to degeneration/rupture of tendons.
- Physical Therapy: Guided physical therapy focusing on eccentric strengthening, stretching, and mobility can improve outcomes if initial measures fail.
- Surgery: Only considered when all conservative measures fail. Surgical options may include tendon debridement or repair.
Avoid:
- Barefoot or unsupportive shoes: Lack of heel support increases stress on the tendon.
- Sudden increases in activity: Jumping, sprinting, or hill running can worsen symptoms.
Stretches / Exercises
Foot dorsiflexion stretch with band/belt/towel
- Be in a comfortable position to allow your leg to stretch out
- Maintain knee extension (straight leg) position the entire time
- Take a workout band/belt/towel and wrap the tool around the metarsal heads (balls) of your foot
- Dorsiflex the foot (toes-to-nose) using only your hands, do not use your leg muscles to assist your foot dorsiflexing at any time (picture below)
- Return to a relaxed position and repeat
- Complete this stretch for 15-20 repetitions for 3 sets total. Perform exercise 3-5x per week during acute Achilles tendinopathy pain.
Eccentric Heel Drop:
- Stand on the edge of a step on the balls of your feet, heels off the edge.
- Rise onto both toes, then slowly lower the affected heel below the step using only that leg.
- Perform 15-20 repetitions for 3 sets, 1-2x daily during acute pain phase.
- Once pain-free, continue 3-4x per week for maintenance.
