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Take the load off your feet: how to deal with achilles tendinopathy

A painful achilles used to be referred to as tendonitis, but the changes that occur within the tendon do not follow a normal inflammatory/healing process and, because of this, RICE (rest, ice, compression, elevation) does not work with achillles tendinopathy. Instead, there are cellular changes to the tendon and to the arrangement of collagen fibres, as well as its supporting system, the matrix. This does not make the tendon weak, but it does make it difficult for it to tolerate loads. It is correcting this that is at the heart of treatment. There are certain risk factors that may lead some people to developing achilles tendinopathy, many of which relate to changes in load through the tendon…

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 Achilles Tendinopathy (Achilles Tendonitis)

Jill Cook’s group is probably the leading research group in the world on tendinopathy, specifically in the lower limb. It’s now theorized that most cases of chronic tendon pain are related to this “degenerative” tendinopathy, and acute cases are “reactive” tendinopathies. The actual “why does it hurt?” is also still pretty debatable, but it’s theorized that small tendon cells die off in an inflammatory process initially and their cell matrix becomes disorganized.

Articles of Interest

A treatment algorithm for managing Achilles tendinopathy: new treatment options

Achilles tendinopathy affects athletes, recreational exercisers and even inactive people. The pathology is not inflammatory; it is a failed healing response. The source of pain in tendinopathy could be related to the neurovascular ingrowth seen in the tendon's response to injury. The treatment of Achilles tendinopathy is primarily conservative...

Achilles tendinopathy: aetiology and management

The aetiology of tendinopathy remains uncertain and many factors have been implicated,1 including free radical damage occurring on reperfusion after ischaemia, hypoxia, hyperthermia and impaired tenocyte apoptosis.

Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments

Achilles tendinopathy is one of the most frequently ankle and foot overuse injuries, which is a clinical syndrome characterized by the combination of pain, swelling, and impaired performance. The two main categories of Achilles tendinopathy are classified according to anatomical location and broadly include insertional and noninsertional tendinopathy. The etiology of Achilles tendinopathy is multifactorial including both intrinsic and extrinsic factors.

Achilles Tendonitis – Non-Insertional

Achilles tendonitis is characterized by pain and swelling in the Achilles tendon. Non-Insertional Achilles tendonitis (occurring above the insertion) is often associated with an increase in activity level and tends to occur in patients in their 30s and 40s. Treatment is usually nonoperative and includes an initial period where the symptoms are allowed to settle, followed by a gradual return to activity.

The Runner’s World Guide to Common Running Injuries: Achilles Tendinitis

Learn the warning signs, the right strengthening exercises, and the recovery strategies to keep Achilles pain from becoming a major injury.

Resources

Physiopedia

Achilles tendinopathy (common overuse injury) refers to a combination of pathological changes affecting the Achilles tendon usually due to overuse and excessive chronic stress upon the tendon. It can be seen both in athletes and non-athletes. It may or may not be associated with an Achilles tendon tear. A lack of flexibility or a stiff Achilles tendon can increase the risk of these injuries.

Foot Files

Symptoms of Achilles tendonitis include pain, aching, stiffness, tenderness and discomfort in the area above the heel that increases when stretching or standing on your toes. People with Achilles tendonitis often have difficulty flexing the heel (calcaneous bone) and calf (which consists of the gastrocnemius muscle and soleus muscle). There are two types of Achilles tendonitis: noninsertional, which is when the fibers in the middle portion of the tendon start to break down with tiny tears, and insertional, which is when fibers in the lower portion of the tendon start to break down with tiny tears.

Harvard Health

Without treatment, this condition can become a long-term problem, increasing the chances of breaking (rupturing) the Achilles tendon. Achilles tendonitis is usually caused by overuse. It is common in runners and other athletes. Sometimes it is a sign of a body-wide joint condition such as ankylosing spondylitis. Wearing poorly fitting shoes, or wearing high heels every day, can also cause Achilles tendonitis.

OrthoInfo

Simply defined, tendinitis (also spelled "tendonitis") is acute inflammation of a tendon. Inflammation is the body's natural response to injury and often causes swelling, pain, or irritation. You may also come across the term "tendinopathy," which is used to describe a condition in which the tendon develops microscopic degeneration (wear) as a result of chronic damage over time. Tendinitis, tendinosis, and tendinopathy are all common terms which essentially refer to the same problem

The Feet People

There’s a condition similar to Achilles tendinopathy called Achilles tendonitis. Although people may use the terms interchangeably, Achilles tendinopathy and Achilles tendonitis are different conditions. Tendonitis occurs when the tendon becomes inflamed, often due to sports or other activities. ‘itis’ actually means “inflammation of”. Tendinopathy is a degenerative condition (degenerating over time) that is thought to be caused by repeated tiny injuries to the tendon. A tendinopathy needs a different treatment approach than just focusing on reducing inflammation. This is where working with a podiatrist who is experienced with understanding these two conditions and the difference between them can make all the difference.