Achilles Tendinopathy

Your Achilles tendon, which is the thickest tendon in your body, connects your calf muscles to your heel bone (calcaneus). You use this tendon when you perform activities like walking, running, and jumping. A sudden increase, overuse, in the amount or intensity of activities like these can cause the tendon to become stressed and inflamed. You may have one of two types of tendinopathies depending on which part of your tendon is swollen. If you have non-insertional achilles tendinopathy, which usually affects young active people, the fibers in the middle of your tendon have torn causing swelling and pain.  If you have insertional achilles tendonitis, fibers have torn in the lower part of the tendon where it connects to the heel bone. This often causes bone spurs (an extra growth of bone) to develop.

Symptoms

• Pain in the achilles tendon in the morning or first few steps after sitting
• Tenderness to the touch
• Swelling of the tendon (you can often feel a bump)
• Feeling of calf tighness
• Bone spur associated with insertional tendonitis

If you experienced a “popping” sensation in the back of your heel or if your pain is persistent, you may have ruptured your achilles tendon. A physical therapist is trained to diagnose the severity of your condition, and if surgery is a likely outcome, they will refer you to the appropriate surgeon.

Treatment

Physical therapy is a very important resource for treating Achilles Tedinopathy, especially for those suffering from non-insertional tendonitis. Your physical therapist will aim to reduce pain and swelling in the area and increase your strength, flexibility, and control. Physical therapists are trained to assess your situation and create a recovery plan that’s specific to your needs. Below are some examples of what you can expect:

• Heat/Ice treatment
• Soft tissue mobilization
• Joint mobilization
• Mobility training
• Progressive resistance exercise
• Proprioception & balance exercises

The therapist will also provide you with a specialized home exercise program and teach you to perform the exercises correctly ensuring the quickest recovery.

Your physical therapist can also help you safely ease back into your prior activities at the right time.  He or she may recommend orthotics (custom or over the counter) or heel lifts in order to help you find relief as your recover.

If your pain doesn’t improve after six months of conservative treatment, your physical therapist may recommend a physician to evaluate your need for surgery. The doctor will recommend a specific type of surgery based on which part of your tendon is injured and how bad the tear is. If you choose to have surgery, physical therapy will play an important role in your recovery after the operation. It may take a full year of post-surgical treatment until you can return to full physical activity pain-free.

Physical Therapy Exercises

The following are examples of exercises you may be prescribed in a physical therapy clinic. Please remember these do not apply to everyone and depend on your specific condition.

• Ankle Circles: Stand up straight and elevate your injured foot by flexing the knee. Slowly circle your foot in the air for 30 seconds and repeat.
• Calf Stretch: While standing, face a wall and place your hands against it as you lean forward. Keep affected leg’s knee straight and place the unaffected leg in front with the knee bent. Push your hips toward the wall and hold for 45 seconds. Relax and repeat. You should feel a strong stretch in your calf.
• Sitting Heel/Toe Raise: Sit on a chair and rise up onto your toes as high as you can without pain. Lower heels slowly and gently lift up your toes. Repeat.
• Standing Heel Raise: Stand up straight and rise up onto your toes using both feet. Lift up your nonaffected leg and then slowly control your lowering down with the the affected leg only. Repeat.

Prevention

Follow the guidelines listed below in order to help prevent Achilles Tendinopathy:

• Walk for a few minutes and complete a dynamic warm-up before running.
• Do calf-strengthening exercises weekly.
• Stretch your calf muscles and achilles tendon.
• Increase your level of activity gradually.
• Alternate high impact activities (like running) with low-impact activities (like cycling).
• Wear supportive shoes, and limit time in high heels.

Think you might be dealing with an Achilles Tendinopathy? Interested in preventive care?  Contact MTS for an hour long 1-on-1 evaluation with a PT to get started!