Issue 2 - June 2004

This Months Patient Advice : Achilles Tendonitis by Amanda Adams

It is estimated that 11% of all running injuries are due to Achilles Tendonitis.

achilles.jpgThe Achilles tendon (TA) is a large tendon at the back of the ankle that connects the large calf muscles (gastrocnemius & soleus) to the heel bone (calcaneus).

Like ligaments tendons are strong but not particularly flexible. It can become inflamed through overuse and other contributory factors. The TA has a poor blood supply which is why it can be slow to heal and is less resilient to micro-trauma.

SYMPTOMS

  1. Pain and tenderness over the tendon (commonly about 3cms above the insertion)
  2. Swelling around the tendon
  3. Pain and stiffness especially taking first few steps in the morning
  4. Limited ankle flexibility
  5. Lumpy build up of scar tissue (pump lump)

Achilles tendonitis is often an ailment of athletes because they do activities that involve sudden stops and starts as well as jumping that stress the tendon.

achilles2.jpgOTHER CAUSES

  1. Overuse of the tendon with tight calf muscles
  2. Increase in activity / duration of training
  3. Improper footwear/ training surface
  4. Excessive pronation

If your feet roll in (flat arches) this will increase the strain on the TA because it twists the muscle and causes inflammation.

WHAT CAN THE PATIENT DO?

Initial management is aimed at reducing oedema (swelling), pain and resolving inflammation.

  1. Rest and apply cold therapy or ice
  2. Wear a heel raise which will take some of the strain
  3. Anti-inflammatory drugs

WHAT CAN PHYSIOTHERAPY DO?

  1. Identify the causes and prescribe orthotics to correct foot biomechanics if needed
  2. Advice on how to change your training methods
  3. Tape the back of the leg to take the stretch off the tendon
  4. Ultrasound / Acupuncture treatment to reduce pain and inflammation
  5. Soft tissue mobilisation
  6. Prescribe an eccentric rehab. programme (see next page)

Continued on next page »

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