The Achilles tendon is the thickest tendon in your body and it is located at the back of your lower calf and ankle. It connects your calf muscles to your heel bone (calcaneus) and it is an important muscle that acts to push off your heel during walking, running or jumping.
Due to the large amount of load put on the tendon, it can sometimes create chronic, microscopic tears within the tendon, causing gradual onset of symptoms with no specific triggering incident. Less commonly are acute, traumatic Achilles tendon ruptures during sports or forceful ankle movements during activities. Achilles tendinopathy can affect the tendon either at the mid-portion or the distal portion where the tendon joins to the heel bone.
People with Achilles tendon pathology present with pain at the back of the heel made worse on weight-bearing after a period of sitting or on getting up after a night’s rest. Prolonged walking or standing may aggravate the pain. There may also be other symptoms like warmth, tenderness on palpation, stiffness and weakness in the calf muscle.
Achilles tendinopathy is more common in those with flat feet or excessively high arches, individuals who over-train or have poor training technique and also in those who have tight calf muscles. Your physiotherapist will assess your foot biomechanics and also look at your sport technique to find out the cause(s) of your problem.
In the acute phase, management is aimed at pain relief. Ice and anti-inflammatories are used to reduce the initial pain, swelling and inflammation. You may need to reduce the amount of weight put on your affected leg by using crutches if the pain is severe. Your physiotherapist may strap up your foot with rigid sports tape or prescribe an orthosis if necessary.
Depending on the cause(s) of your symptoms, your physiotherapist will use techniques such as manual therapy, massage, dry needling or electrical therapy to reduce symptoms. After the acute stage, it is important to restore calf muscle length and strength. Depending on which portion of the tendon is affected, your physiotherapist will teach you how to stretch and strengthen the Achilles tendon. It is also important to work on the core and hip muscles as weakness in those area can contribute to problems in the ankle and feet.
Your physiotherapist will work with you to develop an individualised training program that comprises of flexibility training, strength training and proprioceptive training (balance training) so that you can return to your activities safely and prevent this condition from recurring.
Example rehab exercises: