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Achilles tendinopathy

Published by Bupa's health information team, November 2009.

This factsheet is for people who have Achilles tendinopathy, or who would like information about it.

A tendon is a tissue that connects a muscle to bone. Achilles tendinopathy is when your Achilles tendon becomes injured, causing pain and stiffness just above your heel bone.

About Achilles tendinopathy
Symptoms of Achilles tendinopathy
Causes of Achilles tendinopathy
Diagnosis of Achilles tendinopathy
Treatment of Achilles tendinopathy
Prevention of Achilles tendinopathy
Questions and answers
Related topics
Further information
Sources

About Achilles tendinopathy

The Achilles tendon is very strong. It's located at the back of your ankle and connects your two calf muscles to the bone in the heel of your foot. The tendon is made up of many collagen fibres.

There are several ways in which the tendon can become injured, leading to Achilles tendinopathy. The tissue surrounding the tendon may become inflamed, the tendon may become worn down (degenerate), cysts (small sacs of fluid) may form inside the tendon, or tiny tears may form in the fibres.

Illustration showing the Achilles tendon
The Achilles tendon

This type of injury occurs most often in athletes, but it can affect anyone.

Symptoms of Achilles tendinopathy

The main symptom is pain and stiffness just above your heel bone that develops gradually. At first you may only have pain after rest, such as first thing in the morning. The pain may improve with exercise to begin with.

Over time, as the problem worsens, you may have pain after exercise and finally pain during exercise. The tendon above your heel may appear slightly swollen and feel stiff.

Causes of Achilles tendinopathy

Achilles tendinopathy is usually caused by overuse and is a common injury in sports that involve running and jumping. Repeated stress on the tendon can cause microscopic changes to occur.

Achilles tendinopathy is more likely to happen if you:

increase your activity levels too quickly (mileage, speed and type of activity)
don't leave enough recovery time between training sessions
change your usual training surface
wear inappropriate footwear
have poor movement (biomechanics) in your feet - for example, flat feet
have poor movement (biomechanics) in your lower limb - for example, poor calf flexibility
have a poor range of movement in your ankle

Diagnosis of Achilles tendinopathy

Your GP or physiotherapist will ask you about your symptoms and examine you. He or she will also ask you about your medical history.

You may need to have further tests to look at the damaged Achilles tendon. These can include:

an ultrasound scan, which uses high-frequency sound waves to produce an image of the Achilles tendon to look for any changes to the tendon tissue
an MRI (magnetic resonance imaging) scan, which uses magnets and radiowaves to produce two- and three-dimensional pictures of the leg that can help your doctor to see if there is any fluid or tears in the Achilles tendon

Treatment of Achilles tendinopathy

Treatment depends on how serious the injury is. Achilles tendinopathy normally requires treatment.

Self-help

There are a number of things you can do to help Achilles tendinopathy.

Wear a small heel raise in each shoe to help reduce the load on your Achilles tendon and give immediate relief of pain when walking.
Reduce the intensity and length of time you spend exercising.
Wear supportive footwear.
Avoid bare feet around the house.
Stretch your calf muscles.
Apply ice for 10 minutes every two to three hours in the acute phase. Never apply ice directly to your skin as it can give you an 'ice burn' - always place a cloth between the ice and skin.

Medicines

You can buy painkillers such as paracetamol to treat mild and moderate pain. Anti-inflammatory medicines, known as non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen also help to relieve pain and stiffness. Always read the patient information that comes with your medicine, and if you have questions, ask your pharmacist or doctor for advice.

Your doctor or physiotherapist may suggest an injection if other treatments don't work. This is either an injection of steroid and local anaesthetic, which is directed using ultrasound, or an injection of Aprotinin. Injection therapy using Aprotinin is relatively new, so not all doctors or physiotherapists will offer it.

Physiotherapy

Your GP may refer you to a physiotherapist (a health professional who specialises in movement and mobility). You can also choose to see a physiotherapist privately. He or she will give you a programme that will include stretching, strengthening and icing your Achilles tendon. You should carry out the programme daily and it can take around three months before your symptoms improve. Your physiotherapist may also use various techniques to help speed up the healing of your Achilles tendon such as soft tissue massage and acupuncture.

Treatment may involve you using orthotics (special insoles you wear in your shoes) to re-align your foot and reduce stress on your Achilles tendon. This will help to alleviate your symptoms and prevent further injury.

Surgery

Your doctor may recommend surgery if your symptoms don't improve after six months of treatment.

Prevention of Achilles tendinopathy

There are some precautions you can take to try to reduce the risk of damaging your Achilles tendon.

Exercise regularly to maintain a good level of fitness. This will mean your muscles are stronger and better able to support your joints, including your knees. If you haven't been active for a while, start gently and gradually increase the intensity and length of time you spend exercising.
Spend five to 10 minutes warming up before exercise to increase blood flow to your muscles and reduce the chance of an injury. Many sports professionals advise stretching your muscles after warming up and again after cooling down; however the benefit of stretching before or after exercise is unproven. You can include a calf muscle stretch, which will lengthen the Achilles tendon.
If performing high-impact exercise such as running, take your running shoes to a specialist shop and ask for advice about whether they are right for running. An experienced adviser will watch you run and can recommend suitable shoes for you.