Achilles Tendonopathy
The Achilles tendon is the large tendon at the back of the ankle that attaches the calf muscle to the heel bone.
When it is injured it can become painful stiff and swollen. This is called tendinopathy.
How is it caused?
Achilles problems are more common in middle age and can affect both athletes and sedentary people. As the tendon gets older, it becomes stiffer but weaker and can get tiny micro-tears.
There are two types of Achilles tendinopathy:
- Non-insertional tendinopathy which affects the body of the tendon
- Insertional tendinopathy, which affects the insertion of the tendon into the heel
What are the symptoms?
Intense sharp pain is often mixed with a constant dull ache. The symptoms tend to be much worse first thing in the morning or after standing for long periods. In some cases, the pain can be so severe that the patient develops a limp and finds walking at normal pace, impossible. Symptoms can wax and wane, but if not treated the pain continues and can be very debilitating. In rare cases, the tendon can rupture.
How is it diagnosed?
Clinical examination determines if there is a problem with the tendon. Ultrasound or MRI help to determine the precise nature of the problem which will help to direct management.
How is it treated?
What can I do?
Simple measures such as anti-inflammatory medication (tablet or cream) can help in the early stages.
A heel lift can help to take the tension off the tendon.
Non-Surgical Treatment
Laser therapy and acupuncture may help selected patients.
Physiotherapy is the mainstay of treatment and usually very effective.
Note that exercises for non-insertional versus insertional tendinopathy are different and can make symptoms worse if applied to the wrong condition, or when the tendon is acutely inflamed and painful.
ESWT, Extracorporeal Shock Wave Therapy can be extremely effective in resistant cases.
PRP Therapy (Platelet Rich Plasma – sometimes called ACP)
Surgical Options
Achilles Tendon Release (Endoscopic) – is a surgical procedure that involves cutting through or disconnecting the Achilles tendon, where it attaches to the calf muscle (gastrocnemius).
