What is the Achilles?
The Achilles is the tendon at the back of your ankle and connects your calf muscle to your heel bone (calcaneum). Your Achilles tendon allows you to walk, run and jump and is the largest tendon in the body. Its function is to help to bend the foot downwards at the ankle (known as plantar flexion).
What is Achilles pain?
Achilles pain is most commonly Achilles tendinopathy which causes pain, swelling, stiffness and weakness in the tendon. It was previously known as Achilles tendinitis which means inflammation of the tendon but it is now known that there is little or no inflammation involved so is known as a tendinopathy. It is thought to be caused by repetitive small injuries (microtrauma) to the tendon.
What causes Achilles pain?
There are many reasons why Achilles pain can develop. It usually comes on gradually but if you experience sudden Achilles pain and have difficulty walking it may be due to a rupture (either complete or partial) so seek medical advice immediately if those symptoms develop. The following a common causes of Achilles pain.
- Overuse of the Achilles tendon – especially for people who run regularly
- Having poor flexibility particularly in the calf muscles and hamstrings
- Having a high arch or conversely being flat footed
- Poor training or exercising techniques e.g. poor running technique or exercising on hard surfaces or slopes
- Changes in your training programme e.g. a sudden increase in intensity
- Training wearing inappropriate footwear
What are the symptoms of Achilles tendinopathy?
- Pain – this can be anywhere from the heel to further up the tendon but is most commonly in the middle of the tendon. Severe pain that comes on suddenly with difficulty in walking may be a tendon rupture so seek medical advice immediately. People often find with Achilles tendinopathy that their pain is worse first thing in the morning then eases off and that their pain is worse at the beginning of a run then eases of and then worsens again once they stop exercising and stiffen up.
- Tenderness on touch of the Achilles tendon
- Thickening of the tendon
Diagnosis of Achilles pain
This is done through a thorough subjective assessment asking specific and directed questions followed by a full objective examination tailored to you including looking at your function, movement, foot position, flexibility, balance, proprioception (awareness of where your joint is in space) and palpation (touching) of the affected area.
There are several causes of pain in the Achilles region and these causes may get missed if a thorough assessment is not carried out. Here at AMS we pride ourselves in carrying out thorough, appropriate assessments to rule out other causes of pain in this region and your therapist will carry out specific tests to differentiate where the pain is coming from.
Physiotherapy treatment for Achilles pain
This will be specific to your injury and tailored to the assessment findings but may include:
- Soft tissue mobilisations of the tendon and calf muscles
- Specific advice and exercises
When to seek help from a physiotherapist
If you experience sudden pain in the Achilles region and have difficulty walking seek medical advice immediately otherwise you should seek physiotherapy help if your Achilles pain does not resolve within 2 to 3 weeks. If your Achilles pain has resolved it may still be beneficial to seek advice from a physiotherapist due to the complex nature of the causes of Achilles pain and to prevent re-injury.