Could your ankle pain be Achilles tendinopathy?

Now before some of you wonder what we are going on about now, let me start by saying this is not a blog about an infamous Greek Demigod, but rather that large tough bit of tissue at the back of your ankle.

What is Achilles Tendinopathy…

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Located at the base of your heel is the large tendon of your ankle which leads up into your soleus (or calf) muscle, connecting the muscle to the body. So why is it called a tendinopathy and not tendonitis? No this isn’t down to Brexit, but more to do with a better understanding of the human body and how it reacts to injuries and strains.


“Achilles Tendinopathy” not the old money term of “tendonitis” is different from the latter as it is the long-term overuse that results in a deterioration of the tendon without any associated inflammation. This is then similar to many tendon injuries, such as tennis elbow and golfer's elbow. Whereas “tendonitis” is the inflammation and irritation which causes a deep, nagging pain that limits easy, comfortable movements.

What causes Achilles tendinopathy?

Like most things, with injuries there are a number of varied causes of Achilles tendinopathy, the more typical tendinopathies are often associated with long-term overuse causing the deterioration within the tendon, without it looking inflamed. Causes can come about both in and out of the sporting world.


Sporting activity can cause Achilles tendinopathy

With participating in any sporting activity, a poor technique or biomechanical issues cause this repetitive strain injury. Having this assessed is crucial to the recovery quality of the injury. Equally improper warm up is a big factor which affects tendon injury risks.


Overuse outside of sport can cause Achilles tendinopathy

Outside of the sporting world tendinopathies are just as common, due to the overuse nature of the injury. The result of repetitive use, stress and trauma to the soft tissues of the body (muscles, tendons, bones, and joints) without proper time for healing, are commonly known as cumulative trauma or repetitive stress injuries. Simple daily tasks such as walking and other current injuries which put extra pressure on the ankle are massive factors affecting the injury risks. This again links back to biomechanical errors of movement.


Other common causes are listed below:

  • Possible family history of the condition.

  • A personal previous history of tendon or muscle injury.

  • Common personal health condition such as arthritis, diabetes, high blood pressure, obesity (weighted pressure onto the joint).

  • Having high cholesterol level


What symptoms will I have if it is Achilles tendinopathy?

The most common or main symptoms of Achilles tendinopathy are an ever-growing stiffness and increasing pain normally at the back of your ankle and within the joint itself. The tendon might feel tender when you touch it and there may be a grating noise or creaking feeling (known as crepitus) when you move your ankle.

This may not always be constant however, as it may be worse first thing in the morning or after you’ve done any exercise or activity. The Achilles tendon may feel particularly stiff when you first get up or if you haven’t moved for a while. The stiffness may ease off when you start moving again. If this starts to affect your daily life and activity quality, then it is time to have it assessed and treated.


However, if you have a sudden occurrence of pain at the back or in your heel or calf, which quickly becomes swollen, bruised and tender, this can mean you have torn the tendon. You may actually hear a loud snap. This is called an Achilles tendon rupture. You should get urgent medical attention if this happens, there has been times where previous clients have come in with this having occurred and the only course of action for myself to take is to ring an ambulance. On the lighter side of things however, we are more than happy to treat an irritated and painful ankle tendon, to help ease the annoying and painful sensations you have.


Treatment for Achilles tendinopathy

The first and important point to make about treatment of Achilles tendinopathy is that it gets harder to treat the longer you leave it before getting a diagnosis, this then affects the type of treatment you require. Don’t leave it too long!

Generally, if it the injury isn’t too severe you should see an improvement after three months. For treatments of Achilles tendinopathies there are 3 different stages of treatment that you could potentially go through depending on the severity of the condition: Medicines, Physical Therapies, and Surgery.

Medicines

Paracetamol and ibuprofen are good sources of pain relief and anti-inflammatories, as they are Non-steroidal anti-inflammatory drugs (NSAIDs). Please confirm with a doctor before consumption if you are currently on medication of course. These are normally advised by your therapist when you start the rehabilitation process, alone they most likely will not be enough and will not fix the problem.

Physical therapies

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These are your best course of action to treat Achilles tendinopathy as they will help to easy the tightness of the muscles through massage and then strengthen the tendon and surrounding muscles to repair the damage caused, and therefore reversing and easing the problem and pain you have.

Surgery

Worst-case scenario requires surgery and will potentially be needed to improve tendon if the physical therapies don’t work after an intense period of trying.


Exercises / tips / insights to help achilles tendinopathy

With advice on Achilles tendinopathy rehabilitation exercises, it is important to seek the advice of your therapist who can prescribe the appropriate exercises for you at that time in the injuries phase of healing.

However, the most common exercises to do are heel raises.

  • Begin with a slow raising of your heel and a slow lowering of your heel to help strengthen and eccentrically load the tendon. This helps rebuild the tendon and the muscles around it.

  • The priority will be to fix and remove any biomechanical movement errors to relieve and correct the pressure on the tendon, an example of this being correcting someone’s walking style (gate).



Finishing points

Identifying and diagnosing the problem can be a complicated process so please contact a therapist to fully assess the pains you may be having. Diagnosing the correct condition (tendinitis vs tendinopathy) will be crucial to your recovery, as they require different treatment plans.

Does this describe what you’ve been feeling?

Would you like treatment or further advice to help treat and/or avoid this the future?

Contact us today;

Harry Sherlock BSc, MSc.

Sports Therapist and Strength and Conditioning Coach.