Achilles Tendinopathy

Achilles tendinopathy is pain and stiffness in the Achilles tendon, the strong tendon that joins the calf muscles to the back of the heel. It is common in runners and active people, but it can affect anyone, and it usually develops gradually when the tendon is asked to do more than it can cope with.

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Symptoms

Pain and stiffness at the back of the heel or just above it
Pain and stiffness that are worst first thing in the morning, or after sitting or resting
Pain at the start of exercise that may ease as you warm up, then return afterwards
A tender, thickened area or lump on the tendon
Swelling at the back of the ankle

Common causes

A sudden increase in training, such as running further or faster, or adding hills or speed work
Tight calf muscles
Faulty foot biomechanics, for example feet that roll in too much when walking or running
Worn or unsupportive footwear, or a sudden change to flatter shoes
Age, as the tendon becomes less able to cope with load from around the age of 40
Weight gain
Some medicines, such as certain antibiotics

What else can look similar

Achilles tendon rupture
Bursitis at the back of the heel
Heel spurs
Sever’s disease, in children
Plantar fasciitis
Impingement at the back of the ankle

What you can try at home

Reduce the activities that make the pain worse, rather than resting completely
Cold compresses or ice after activity
Avoid going barefoot and wearing very flat shoes
Gentle calf stretches, unless the pain is right where the tendon joins the heel bone
Pain killers such as paracetamol
If you felt a sudden snap or sharp pain at the back of the ankle, as if you had been kicked, seek urgent medical help as this can be a tendon rupture
If the pain is ongoing or recurring, it needs a professional podiatry assessment and diagnosis

How we can help

A physical examination and a clear diagnosis
A progressive loading exercise programme to strengthen the tendon and calf, under the guidance of an HCPC registered podiatrist
Advice on footwear and on adjusting your training while the tendon recovers
Heel raises to reduce the strain on the tendon in the short term
A biomechanical assessment to find the underlying causes
Running video gait analysis for runners
Foot orthoses, ranging from off the shelf and semi bespoke to tailor made
Acupuncture
Referral for a scan or specialist opinion in severe or unresponsive cases

Which appointment to book

If you have symptoms that sound like Achilles tendinopathy, you are recommended to book one of the following appointments:

A biomechanical assessment, for a full assessment of how your feet and legs move
A musculoskeletal (MSK) consultation
Running video gait analysis, if you are predominantly a runner

If you are not sure which appointment is right for you, call us on 02920 644900 or email info@feetinfocus.com and we will help.

Common questions

Should I stop running with Achilles tendinopathy?

Not always. Complete rest often makes the tendon weaker, and it can flare up again when you return. Most people can keep running at a reduced level as long as the pain stays mild and settles by the next morning. Your podiatrists will help you adjust your training and build the tendon back up with a structured exercise programme.

How long does Achilles tendinopathy take to heal?

Tendons are slow to recover. With a consistent exercise programme, most people notice an improvement within six to twelve weeks, but it can take three months or more to settle fully, and longer if the problem has been there for a long time. Starting treatment early usually means a quicker recovery.

Will stretching help my Achilles pain?

It depends where the pain is. Gentle calf stretches can help when the pain is in the middle of the tendon, but stretching over the edge of a step can make things worse when the pain is where the tendon joins the heel bone. Strengthening exercises are usually more important than stretching, so it is best to have the problem assessed first.