Achilles tendinopathy is an injury to the band of tissue (tendon) that connects the muscles in your lower leg to your heel bone. You may get pain, stiffness and sometimes swelling around the tendon or where it inserts into the heel bone. It’s a common injury, especially if you’re very active or do lots of sports.
About Achilles tendinopathy
Your Achilles tendon is the thickest and strongest tendon in your body. It connects your calf muscle to the bone in your heel, helping you raise your heel, when you walk, run, climb, or jump.
If you have Achilles tendinopathy, your Achilles tendon becomes damaged and stops working as well as it should. It’s usually damaged through repeated use and injury over time. The damage can make it painful and harder to do your usual activities.
You may sometimes hear Achilles tendinopathy called Achilles tendonitis. This means your tendon is inflamed. But because there isn’t always inflammation when your tendon is injured, this term isn’t strictly accurate.
Achilles tendinopathy symptoms
Achilles tendinopathy can cause several symptoms, including:
- pain in your heel – this may be an ache or a sharp pain, which feels worse when you’ve been active or put pressure on it.
- stiffness in your tendon – often this is worse first thing in the morning or if you’ve been resting for a while.
- swelling at the back of your ankle
- tenderness when you touch your tendon.
- a grating noise or creaking feeling (crepitus) when you move your ankle.
Causes of Achilles tendinopathy
Achilles tendinopathy is usually caused by overuse – this means repeated stress on your Achilles tendon over time. This can cause changes to the structure of your tendon and sometimes tiny tears, making it weaker and painful.
Any sports or activities that put stress on your Achilles tendon can lead to Achilles tendinopathy. This includes running and anything that involves jumping – for example, dancing, gymnastics, squash and tennis. You may also be more likely to damage your Achilles tendon if you:
- use badly designed equipment including wearing unsupportive footwear or footwear that compresses the tendon.
- suddenly increase how much exercise you do or the intensity of your exercise.
- train on hard or sloping surfaces.
Other things that can make you more likely to develop Achilles tendinopathy include:
- getting older – because your Achilles tendon becomes less flexible or elastic, causing it to have less tensile strength.
- having a family history of the condition
- if you’ve injured your tendon or the muscles around it in the past
- having certain long-term health conditions
- having certain problems affecting your feet or legs
- being very overweight or obese
- taking certain medications
Easing symptoms for Achilles tendinopathy
There are several things you can do to ease the symptoms of Achilles tendinopathy, without needing to see a health professional. These include the following.
- Rest your tendon by reducing (or stopping) the activity that triggered your symptoms.
- Apply cold packs or ice wrapped in a towel to ease your pain and reduce any swelling.
- Analgesics such as over the counter paracetamol or Ibuprofen.
Try to continue weight bearing if possible. You may be able to do some exercises that don’t put too much stress on your Achilles tendon – such as swimming. Whilst the acute pain settles.
You can gradually restart your normal activities once the pain starts to ease. But avoid uphill and downhill running until the pain has completely gone and stick to softer running surfaces. You should also make sure you warm up well and do plenty of calf stretches.
You might find heel lifts helpful. These are insoles that you fit into each of your shoes. They can reduce the stress on your Achilles tendon and ease your symptoms. It may also help to see a podiatrist – a specialist in conditions affecting the feet. They can advise you about wearing the right footwear to suit your feet, posture and activities.
Seeking help for Achilles tendinopathy
If your symptoms don’t improve after a week or so, you may find it helpful to see a physiotherapist or talk to your GP.
Diagnosis of Achilles tendinopathy
Achilles tendinopathy can usually be diagnosed from your symptoms and an examination and you won’t usually need any further investigations.
Achilles tendinopathy treatment
Treatments will usually involve a physiotherapy exercise programme to address any tight or weak muscles to start with, before moving onto other treatments, if this doesn’t work. Most people find their symptoms improve within 12 weeks.
Physiotherapy exercises for Achilles tendinopathy
Achilles exercises usually start with isometric and then concentric muscle work with some gentle stretches, before moving on to what are known as eccentric exercises. These are exercises that are designed to load your Achilles tendon over time to promote healing and strengthening. They’re known to be particularly effective for Achilles tendinopathy. You’ll probably need to do Achilles tendinopathy exercises for three months to get the best out of them. If you want to return to running/ jumping sports you will need to do more advanced strenuous rehabilitation exercises that involve jumping/ hopping and plyometrics, to restore the tendons tensile strength and rebound capability.
- If your Achilles tendinopathy doesn’t improve with self-help measures or physiotherapy exercises, there may be other treatments you can try. These include the following.
- Extracorporeal shockwave therapy. Is a machine which passes sound shockwaves to the damaged part of your tendon. This may help ease your pain and promote healing of the tendon. You may need several weekly sessions.
- Blood or platelet-rich plasma (PRP) injections. These use part of your own blood that’s rich in growth factors and may help your Achilles tendon to heal faster. Your doctor injects the plasma or blood into or around your damaged tendon, sometimes using ultrasound for guidance.
- Dry needling. This involves passing a thin needle into your tendon with the aim of triggering the healing process and strengthening your tendon.
Prevention of Achilles tendinopathy
- There are several things you can do to help prevent Achilles tendinopathy.
- Make sure you wear appropriate shoes.
- Limit repetitive motions that keep putting stress on your tendon.
- Gradually build up new activities slowly. You should increase the intensity and duration of your activities slowly over time.
- Warm up well before you start exercising and stretch your calf muscle afterwards.
- If you have underlying health problems that put you more at risk, make sure they’re being treated properly.
Aim to maintain a healthy weight because being overweight can increase your risk of Achilles tendinopathy.
Wearing orthotics (special inserts) in each shoe may help if there’s a problem with the shape of your foot or how you walk. You can buy orthotics from pharmacies or other retailers, or they can be custom-made for you by a podiatrist. Ask your physiotherapist or podiatrist for advice.