Achilles tendonitis
This important tendon on the posterior aspect of the ankle is named after Achilles, who according to myth was protected from wounds by being dipped in a magical pond by his mother. She held him by the heel, which was not immersed, and later he died by an arrow wound to his heel.
When the immediate structures around this tendon become inflamed it is called achilles tendonitis.
The achilles tendon is the connection between the heel and the most powerful muscle group in the body. This has long been known as a site prone to disabling injury such as achilles tendonitis. Forces up to 12 times body weight may arise during sporting activity.
achilles tendonitis anatomy
The achilles tendon joins three muscles: the two heads of the gastrocnemius and the soleus. The gastrocnemius heads arise from the posterior portions of the femoral condyles (back of the thigh bone). The soleus arises from the posterior aspect of the tibia and fibula (the two bones in the lower leg).
The gastrocnemius is a muscle that crosses three joints: the knee, the ankle, and the sub-talar joint (major joint in the foot). The functioning of these joints and influence of other muscles on these joints has a significant effect on the tension that occurs within the achilles tendon. Increased tension caused scar tissue to occur in the form of a nodule, this being the major factor in tissue irritation and associated achilles tendonitis.
The bulk of the achilles tendon inserts into the upper back third of the calcaneus (heel bone). Some fibres run further down and insert into the bottom of the heel bone.This part of the tendon is called the watershed and is the major site for achilles tendonitis to become evident.
Achilles tendonitis in runners occurs due to inflammation, strain, or repetitive trauma to the achilles tendon. This occurs usually due to a repetitive activity. The achilles tendon is always in a state of minor injury, a very mild achilles tendonitis. In fact this is necessary to ensure normal function. However increased stress, muscles tightness or sudden trauma can lead to an acute attack of achilles tendonitis type injury..
If this condition is left untreated, it can develop into achilles tendonosis, due to scar tissue developing in the tendon from repetitive micro-trauma. The tendon degenerates and the inury becomes chronic in nature.
The majority of achilles tendon overuse injuries occur in middle aged, athletic males. Runners with with either hypermobile may be at greater risk for developing either achilles tendonitis or its chronic brother, achilles tendinosis. The negative mechanics may put additional stress on the tendon, therefore, placing it at greater risk of injury.
Athletes with a rigid foot type also run a greater risk of all posterior group strains including Achilles tendonitis. A rigid foot type results in early heel lift during the contact phase of gait meaning that the athlete is "on their toes" earlier than is mechanically efficient causing the muscles and tendons in the back of the leg to work harder.
Events that can cause Achilles tendonotis may include:
biomechanics that are inneficient
Running that involves hills such as fell running
Tight posterior muscle groups.
Increasing mileage or speed too quickly.
Increasinf activity after a period of inactivity.
Trauma caused by sustained to off phase of gait such as a sustained sprint.
achilles tendonitis - symptoms
Achilles tendonitis often begins with mild pain after running that gradually worsens.
Other symptoms may include:
localised pain, sometimes severe, along the water shed of the tendon, in the insertion point into the calf muscle or at the insertion point into the heel bone during or a few hours after running.
Morning tenderness along the body of the achilles tendon is attached to the heel bone.
A feeling that your lower leg feels inefficient.
Mild, moderate or severe swelling particularly after a run can be an indicator of achilles tendonitis.
Stiffness that generally diminishes as the tendon warms up when running.
achillles tendonitis
treatment in the acute phase
P - R - I - C - E
Protection - Your ankle may be taped or braced to prevent further injury.
Rest - Achilles tendonitis can lead to rupture of the tendon!. You should rest from all activities that cause pain or limping. Use crutches/cane until you can walk without pain or limping.
Ice - Place a plastic bag with ice on the Achilles for 15-20 minutes, 3-5 times a day for the first 24-72 hours. Leave the ice off at least 1 1/2 hours between applications.
Compression - Wrap an elastic bandage from the toes to mid calf, using even pressure. Wear this until swelling decreases. Loosen the wrap if your toes start to turn blue or feel cold.
Elevate - Make sure to elevate the ankle above heart level (hip level is acceptable during class).
IF SYMPTOMS PERSISTS OR NUMBNESS/ DISCOLOURATION OF THE FOOT OCCURS CONSULT A MEDICAL PROFESSIONAL IMMEDIATELY.
Remember achilles tendonitis can lead to complete rupture of the tendon!
achilles tendonitis
to restore normal function
As we get older (30+) the risk of Achilles tendon rupture goes up dramatically especially if we embark on high impact sporting activities such as running. This is increased still further if activity is continued when achillles tendonitis is present. It must be emphasised that the risk is still small but when recovering after any injury it is vital that when stretching or performing any exercise that there should be no pain. If any tenderness is elicited then stop and re commence P.R.I.C.E
DO NOT EXERCISE THE TENDON IF IT IS SWOLLEN, TENDER OR HOT TO THE TOUCH.
EXERCISE + ACHILLES TENDONITIS = INCREASED RISK OF TENDON RUPTURE!
| Technique: | Sit with your knee straight and hold the foot position as long as possible. Do as frequently as possible for the first 3-10 days. |
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Pullback
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| Technique: | Hold each exercise 30seconds at a gentle stretch. Please do not bounce! |
| Frequency: | 10-20 repetitions/exercise, 5-7 days per week |
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Begin stretching regimen for gastrocnemius and soleus complex. Warning: There should be no pain when doing this exercise. If there is stop! |
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achilles tendonitis
stretching exercises
| Technique: | Hold each exercise 30seconds at a gentle stretch. Do not bounce! |
| Frequency: | 3 sets 10 repetitions/exercise, 5-7 days per week progressing to 3 sets of 15 |
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Begin eccentric exercise program 7-10 days after pain has subsided Warning: There should be no pain when doing this exercise. If there is stop! |
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| Technique: | Hold each exercise 30seconds at a gentle stretch. Do not bounce! |
| Frequency: | 6-10 repetitions/exercise, 5-7 days per week |
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Perform a toe raise on a 4-6 inch box or step with both legs. Once on your toes, lift the uninvolved leg and lower yourself slowly into dorsiflexion (heel down, toe up). Warning: There should be no pain when doing this exercise. If there is stop! |
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Achilles tendonitis
strengthening exercises
| Technique: | Hold each exercise 30 seconds at a gentle stretch. Do not bounce! |
| Frequency: | 3 repetitions/exercise, 5-7 days per week, and incorporate into warm up and cool down exercises. |
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Perform a toe raise on a 4-6 inch box or step with both legs. Once on your toes, lift the one leg and lower yourself slowly into dorsiflexion (heel down) with the other. Repeat on the other side Warning: There should be no pain when doing this exercise. If there is stop! |
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achilles tendonitis prevention of further injury
Please remember that virtually all achilles tendon problems occur at contact phase of gait (when the foot hits the ground) due to increased biomechanical stress at this point. This is particularly relevant when running. No amount of exercising will influence what happens at the point of heel strike, mid-stance and toe off phases of gait if there is a primary biomechanical problem. It is therefore vital to improve your mechanics with orthotics designed for your chosen sport.
Very important- Don't ignore the problem, it won't go away!
Achilles tenonditis cane be caused by functional instability which causes frictional stress and associated trauma to the tendon. It can also be caused by overpull of the tendon which can be a combination of underlying foot shape and tight muscle groups.
The way we function biomechanically is predominantly controlled by genetics, its hereditary (runs in the family). The way you function is set and cannot be cured. What you can do however is control lower limb mechanics by altering foot position during the contact phase of gait. This can only be done by wearing a good shoe and with orthotics (foot beds). This is the cheapest and most cost effective way for any runner to reduce the risks of achilles tendonitis from occurring and from helping to prevent re-injury. Overall costs for the average runner will run into pennies per mile/hour of sport. Orthotics are designed to alter the biomechanics during the time the foot is on the ground. They are also used to provide increased shock absorbency working in harmony with the sport shoe worn.
achilles tendonitis
returning to sporting activity
The goal of rehabilitation is to return you to running as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to running is determined by how soon your achilles recovers, not by how many days or weeks it has been since your injury occurred.
You may safely return to running when, starting from the top of the list and progressing to the end, each of the following is true:
You have full range of motion in the injured achilles compared to the uninjured achilles.
You have full strength of the injured achilles compared to the uninjured one.
You can jog straight ahead without pain in the achilles or limping.
You can sprint straight ahead without pain in the achilles or limping.
You can do 45-degree cuts, first at half-speed, then at full-speed with out pain.
You can do 20-yard figures-of-eight, first at half-speed, then at full-speed without pain.
You can do 90-degree cuts, first at half-speed, then at full-speed with achilles pain.
You can do 10-yard figures-of-eight, first at half-speed, then at full-speed without achilles pain.
You can jump on both legs without pain and you can jump on the injured leg without achilles pain.
Remember to be very careful when returning to your chosen sport as achilles tendonitis can cause tendon rupture!