What is the Achilles Tendon?
The Achilles tendon is the thickest and strongest tendon in the body found in and above your heel. It joins your heel bone (calcaneum) to your calf muscles. The main role of your Achilles tendon is to help bend your foot downwards at the ankle and this movement is called plantar flexion. The tendon helps you move your foot when you walk, run, climb or jump.
What is Achilles Tendinopathy?
Achilles tendinopathy is a condition that can cause pain, swelling and stiffness into the Achilles tendon. This can often occur from irritation to the tendon but normally results from repeated tiny injuries (microtraumas) to the tendon due to overuse over periods of time.
What causes Achilles Tendinopathy?
Achillies tendinopathy is caused by repeated tiny injuries (microtraumas) to the Achilles tendon, leading to the tendon not healing as it should normally do.
Some causes of Achilles tendinopathy can include:
- Overuse of the Achilles tendon
- Training, exercising or working wearing inappropriate footwear.
- Having poor training or exercise techniques - for example, a poor running technique.
- Making a change to a training programme or increased walking at work.
- Training or exercising on hard or sloped surfaces.
What are the common symptoms linked with Achilles Tendinopathy?
Some common symptoms that you may experience:
Pain – Most often located into the heel or mid-portion of the tendon. This may be an ache, or a sharp pain.
Stiffness – This is often worse first thing in the morning or after long rest. May then be uncomfortable to move the foot or place weight through the leg particularly when pushing off on toes.
Swelling – into the back of the ankle or mid-portion of the Tendon
Tenderness – particularly when you touch your tendon
Crepitus - Some people may experience a creaking noise/feeling when moving your ankle, but this is often painless.
Do I need further investigations?
Your healthcare professional may diagnose Achilles tendinopathy based on your typical presenting symptoms and from examining your Achilles tendon. They will feel for swelling or tenderness on or around the tendon. They may also ask you to place stress on the tendon though exercises, but for most people, the movement of plantar flexion (pointing toes) or bringing your heel off the ground during walking will bring on discomfort. They may also squeeze your calf muscle and observe how your foot moves, to assess if there is any further damage or rupture to the tendon.
X-rays or other tests are not usually needed to diagnose Achilles tendinopathy, but an ultrasound scan or an MRI scan may sometimes be suggested by your specialist if the diagnosis is not clear, or to provide further clarity if a rupture of the tendon is suspected. Scans will also be used to further aid preparation for surgery if this is required.
Initial treatments for Achilles Tendinopathy
Exercises –
Eccentric exercise programme
Research conducted into the management and treatment of the Achilles Tendon, concluded that eccentric loading exercise is the best way to manage Achilles tendinopathy. Through this exercise programme, the eccentric exercises ask for you to control the movement and stress through the tendon in a controlled way.
A physiotherapist will be able to offer you tailored exercises to help improve strength and movement at the ankle.
As the strength in your tendon increases, this can increase your tendon’s ability to cope with load. Through completing the exercises in a controlled way this will help to reduce swelling and ultimately discomfort.
It can take up to 6 months for symptoms to reduce so it is important to be consistent throughout completing the exercises
1. Calf stretch – towel
Maintain this position for 10 - 30 seconds, then relax. Repeat 3 times daily.
2. Standing calf stretch
Stand and place your injured leg behind you. Keep your heel on the ground, knee straight and both feet facing forwards.
You should feel a stretch in the calf muscle of your back leg.
Hold for 10 - 30 seconds. Repeat 3 times per day.
3. Soleus Towel Stretch
Hold the towel quite low down, lean back, bend your knee and pull your foot towards you as far as you can until you feel a stretch at back of your leg/calf.
Hold for 10 – 30 seconds. Repeat 3 times per day
4. Standing soleus stretch
Stand in front of a wall and put the foot to be stretched behind the front foot.
Hold for 10 – 30 seconds. Repeat 3 times per day.
5. Seated heel raise
Sitting on a chair, put pressure through the ball of your feet and your big toes and raise your heels off the floor.
Hold for 3 seconds and lower slowly. Aim to repeat this 20 times, then rest for 30 seconds.
Repeat this 4 times. To progress, you can attempt this with some weights on your knee.
6. Standing heel raise
With equal weight on each leg, push up through the ball of your foot and big toe onto your tip toes and lift both heels off the floor. Keep your knees straight and do not lean forwards.
Repeat 10 times. Try to do this 3 times per day.
7. Eccentric loading
Stand with feet equally placed and raise onto your tip toes with both feet. Transfer your weight onto your affected leg whilst fully on your tip toes.
Press through the floor with your calf muscle and lift your unaffected leg off the floor. Hold this position and do not let your heel drop at all for a count to 3.
Then slowly lower your leg back down to the starting position.
Replace other foot and repeat.
8. Single leg heel raise
Lift one leg up off the floor. Push up through the ball of your foot and big toe and lift the heel of your other leg off the floor. Go onto your tip toes. Keep your knee straight and do not lean forwards
Repeat 10 times. Try to do this 3 times per day.
9. Double and single leg progression off step
With the same technique as in exercises 6 and 8, you can complete the exercises off a step once a certain level of strength is achieved.
Do not do these exercises off a step if you have insertional tendinopathy. Only do off a step if directed by your physiotherapist. Otherwise do this on a flat surface.
Orthotics
- During your assessment, your healthcare professional may feel that you may benefit from specialist insoles or footwear to aid the offloading of the stress into your Achilles Tendon.
- Your healthcare professional may recommend you try over the counter insoles or a change of footwear to help raise the heels to offload the stress through your tendon.
- If this is unsuccessful, they may refer you to orthotics for a specialist assessment of your feet and foot alignment to aid the tailoring of offloading insoles or footwear to help to reduce your discomfort and symptoms.
- It must be stated that for some people these may be beneficial but not for others. It is also important to trial these alongside adequately fitting shoes that support your foot and heel.
George Eliot Hospital is a smoke free environment. For help and advice to stop smoking you can call the national helpline on 0300 123 1044 or visit https://
Copyright
Except where otherwise noted, this item is licensed under the CC BY license (https://
If you are a rights holder and are concerned that you have found material on our patient information resources website, for which you have not given permission, or is not covered by a limitation or exception in national law, please contact us using the Feedback form providing your contact information and full details of the material.