What is the Achilles tendon and why can it become painful?
The Achilles tendon is a thick tendon which connects the calf muscles to the heel to control ankle movement. It often has a poor blood supply, so can be vulnerable to injury. The Achilles tendon can often get overloaded when:
- People have poor foot bio mechanics (e.g. very flat footed, or high arches)
- You wear unsupportive footwear (e.g. thongs / flip-flops, or ballet flats)
- If you run long distances (especially in incorrect joggers for your foot type)
- You don’t warm up properly before playing sports
- You have tight calves (often from lack of stretching)
What causes Achilles Tendon pain?
- Achilles tendinopathy – the tendon starts to degenerate, it is no longer smooth and thus does not transmit forces normally from the muscle to the ankle and so gives you pain. This may happen gradually, especially if you are increasing your training load. Or it may happen after some unusual activity, for example if you go on a longer run than usual or on a different surface (on the road instead of on the grass) or if you have been wearing different footwear etc. Pain may be worse when you start exercising and then ease off as you warm-up, only to return later. The tendon often feels stiff after periods of rest or in the mornings. The tendon may appear thicker than usual and may be red. It is tender to touch the tendon. There may be lumps, called nodules within the tendon.
- Achilles tendonitis – inflammation of the tendon, may go hand in hand with Achilles tendonopathy. You can get swelling and irritation of the tendon, which gives pain when you walk or run. Often this will come on gradually or after a long walk or running session, especially if you have been wearing poor or different footwear to usual.
- Achilles tear – is an acute strain where all or part of the tendon is torn, this is more likely to happen if you are older (and the tendon is less elastic) or if you have not warmed up properly before undertaking an explosive sport (e.g. basketball where you would jump and sprint a lot). Often it will be felt as a person starts to take off into a sprint or jump, some people describe it as feeling like you have been kicked in the back of the leg and usually it will start to swell afterwards. If you have torn a significant portion of the tendon, you will not be able to clearly feel the tendon at the back of the leg anymore.
What should I do?
If you think you may have torn your Achilles you need to see your physiotherapist or your doctor straight away to ascertain the degree of the tear, as if it is a big tear it may require surgery. Acute management will need R.I.C.E. (Rest, Ice, Compression and Elevation).
If you are just starting to feel a slight irritation in the tendon, try icing it, rest from the aggravating activity, and wear supportive shoes. If the pain worsens, or does not settle within 48 hours you should seek some guidance from your physiotherapist, who will be able to give you an accurate diagnosis of what is going on. Also he/she will be able to prescribe some exercises (particularly eccentric exercises – or exercising the muscle while it is lengthening to encourage healing in the tendon), stretches and advice to assist recovery.
You can start your eccentric calf raises straight away:
- Begin with standing on a step with both heels over the edge
- Push up with both feet so that you are on the balls of your feet
- Then lift the unaffected leg up, and slowly control lowering down your sore leg until the heel is down as far as it can go.
- Then replace the unaffected leg on the step and start again.
- Start by doing 2-3 sets of 6-10 repetitions.
