Achilles Tendonopathy / Tendinosis

Pain arising from the large tendon inserting into the back of the heel is usually attributable to a tendonopathy (AKA tendinosis or tendinitis) of the  Achilles, named after Homer’s great warrior. It may be either a mid-portion or insertional tendon issue. It is a problem increasingly diagnosed as more people participate in endurance running such as marathons. Pounding the roads on long runs is definitely a risk factor. Suitable footwear with adequate support and sufficient heel cushioning can reduce the chances of its development.

Typical symptoms include pain and tightness down the back of the heel often worse in the mornings and after exercise but may partially ease during activity. Quite commonly both ankles are affected. The pain can be debilitating enough to prevent further running and rarely the tendon can rupture completely.

Traditional medical thought was that the tendon had become inflamed (tendinitis) but recent research suggests that the tendon is failing to repair after the successive small amount of damage that inevitably occurs with training. This accumulation of micro-damage leads to degeneration and loss of function within the tendon and is known as a tendonopathy or tendinosis.

Diagnosis is often made by a clinician but scans can be useful for determining the extent of damage and to exclude other causes.

There are many components to treatment, a fact that reflects that tendonopathy is probably multifactorial in nature. Biomechanical assessment involves analysis of the running style and abnormalities may be correctable with orthotic insoles. Tight calf muscles and ankle joints can be treated by physiotherapy and the doctor might consider  extracorporeal shockwave therapy, injection therapy or even surgery.

Perhaps the most important aspect to treatment is termed an eccentric loading programme. This involves progressively loading the affected tendon in a controlled lengthening process in order to stimulate regeneration of the tendon.

Treatment employed effectively with a graduated return to activity can allow sufferers of Achilles tendonopathy to make a full recovery back to their sport.

Click here for video of management of mid-portion Achilles tendon with extracorporeal shockwave therapy

Click here for video of management of insertional Achilles tendon with extracorporeal shockwave therapy