by Chantal Wingfield

Your Achilles tendon is band of fibrous collagenous connective tissue which attaches your large calf muscles to your heel. It is situated at the back of your ankle.

Contraction of your calf muscles pulls on the Achilles tendon which in turn lifts your heel. This enables us to push up onto our toes, push off the ball of our foot during walking, running, hopping and jumping activities.

This tendon can become inflamed and irritated as a result of overuse. For example a sudden increase in running intensity/distance, an increase in high impact activities or occasionally just a change in footwear.

Symptoms of Achilles Tendinopathy

Pain at the back of the ankle, above the heel. Especially after sporting activities or high impact activities such as prolonged running, jumping, hopping or skipping.

Tenderness in the morning which resolves with gentle movement as the morning progresses.

Pain on palpation of the tendon at the back of the ankle.

Sometimes the area can also become swollen.

Initial Management

Reduce the intensity of your activity.

Reduce high impact activities short term. Swap running for the crosstrainer, cycling or swimming to reduce load through the tendon but maintain your cardiovascular fitness.

Regular ice therapy. 10-20 mins regularly throughout the day, after exercise and when sore.

A short course of Non-steroidal anti-inflamatories can also help. Please check with your pharmacist prior to taking.

Gently stretch your calf muscles for 30seconds daily. Ensure the stretch is pain free.

Key facts

The Achilles tendon is the largest tendon in the body.

It can account for approximately 11% of running injuries.

Tendons have a relatively limited blood supply and thus injuries can take longer to resolve.

Achilles tendinopathy can be an acute injury (short term) or become chronic (recurrent issue over the longer term). So it is worth managing the issue fully upon onset in order to prevent it becoming a chronic problem.

Further Management Options

Addressing your footwear is a key component of your Achilles Tendinopathy management.

Graded increase of your exercise intensity is also paramount.

Bracing/taping techniques can help to reduce symptoms by aiding load transfer through the Achilles tendon.

Research has shown that tendinopathies improve best with eccentric strengthening. This involves exercises which challenge the calf muscles whilst they are lengthening.

Research has also identified a correlation between weak gluteals (buttock muscles) and Achilles tendinopathy. A physiotherapist will be able to identify these areas of weakness and prescribe you specific exercise program to target these muscles.

Cortisone or autologous blood injections are occasionally used in the management of this condition should it not improve with conservative management.

Prevention strategies

Regular strengthening and stretching can help to prevent Achilles tendinopathy.

Specific eccentric strengthening exercises have been found to aid remodelling of a previously injured tendon.

Graded increase of activity no more than 10% each session.

Good footwear.

Good control throughout the lower limb including pelvis, gluteals, knee and ankle.