The Achilles tendon is a tendon that attaches our gastrocnemius (calf muscle) to our heel.  It is one of the strongest tendons in the body and plays a very important role in propelling our body forward.  This is important for everyday tasks such as taking a leisurely stroll or doing intense interval sprints.  Although the Achilles tendon is very important, it does have some anatomical deficiencies with a notable zone of decreased blood supply.  This can lead to breakdown and injury if it is overused.  

Achilles tendinitis is the most common overuse injury of the lower leg, accounting for 5-18% of the total number of running injuries.  Tendinitis means “inflammation of the tendon”.  There is a high incidence in runners, ballet dancers, skaters, soccer players, and basketball players but this injury can happen to anyone. Although the names are similar, there are differences between Achilles tendinitis and Achilles tendinopathy (which is more of a degeneration of the tendon) and the way we treat them.


There are 2 types of Achilles tendinitis which include insertional tendinitis that occurs at the tendon-bone interface and non-insertional tendinitis that occurs 2-6cm above the tendon insertion.  


Pain is the dominant symptom of Achilles tendinitis but often this problem starts as stiffness in the back of the heel after long runs or periods of increased walking.   Without alteration in training, the stiffness becomes pain which may persist through and after the run.  Eventually, the patient may report pain with walking, stairs, etc.  In some advanced cases, pain may be present at rest.  


So how does Achilles tendinitis happen?  One of the most common factors is errors in training.  This may include improper or lack of warm up.  Sudden increases in mileage, intensity, or frequency of training.  Introducing hill workouts to quickly and aggressively and/or running on uneven or hard surfaces can increase the incidence as well.  Returning to quickly from a lay off from activity and overtraining are both common cause of Achilles tendinitis.  Our bodies need time to rest and recover and If we over train, it can lead to calf muscle fatigue and eventual microtears of the tendon. 


Anatomical issues can be factors as well.  This can include muscle imbalances, especially in the calf.  Arches that are too high (supinated) or too low (pronated) can lead to the development of Achilles tendinitis.  Worn out shoes or loose-fitting shoes can lead to higher incidence.  Trauma such as a kick or blow to the Achilles or a laceration (cut) to the Achilles can also lead to Achilles tendinitis.  


The treatment for this condition is aimed at reducing inflammation and giving the tendon rest.  This includes stretching and strengthening, manual therapy (hands on treatment), correcting low back, pelvis, and hip issues.  Electrotherapeutic modalities such as ultrasound, LASER, etc. are often used to help reduce inflammation.  Taping and bracing can be used to help off load the tendon.  Although many people don’t like to hear this, rest and activity modification are an important part of the recovery.  This usually means no hill running or walking and no running or walking on uneven surfaces.  Gradually returning to activities and slowly increasing the load are equally important.  Eccentric strengthening has been shown to be an effective way to strengthen the calf muscles.  Changing shoes and/or adding orthotics may be helpful for some people.  For the seasoned runner who can’t take any time off, pool running can be a very good workout to maintain cardiovascular fitness without overusing the Achilles.  If conservative treatment fails, then surgery may be an option.  


What can I do to reduce my chances of developing Achilles tendinitis?

Regular calf stretching can lower the incidence of Achilles tendinitis.  Patients are also advised to progressively increase their mileage while running and slowly increase your hill runs.  Although your cardio may be improving quickly, you have to allow time for the tendons to adapt to the increased load that is placed on them.  You should also do some strengthening exercises.  Keeping the strength up in the calves can prevent muscle imbalances and improve the muscle and tendons ability to deal with the increased load.  You should also make sure you are wearing properly fitting shoes.  Injuries can happen to anyone but taking a few precautions and slowly increasing your training and exercise can reduce the chances of developing this painful injury.


Adam Bernard is a registered physiotherapist at Dynamic Edge Physiotherapy.