Achilles Tendinopathy

Athletes, fitness enthusiasts and other physically active people who experience pain in the Achilles tendon are often diagnosed with tendinitis, which is defined as inflammation of a tendon.But is your Achilles tendon actually inflamed?

Numerous studies indicate that in most people complaining of Achilles tendon pain, there are no inflammatory cells present. Therefore, the terminology referring to tendon pain has shifted to tendinopathy, meaning that some type of degeneration has occurred in the tendon cells.

Physically active middle-aged males are the most likely to report Achilles tendon pain. Roughly 89 percent of Achilles injuries are sustained by men between the ages of 30 and 50. However, tendinopathy can occur in both sexes, active and sedentary. Twenty-four percent of athletes and about 50 percent of runners develop Achilles tendinopathy at some point.

Anatomy and Function of the Achilles Tendon

As the largest and thickest tendon in your body, the Achilles tendon plays an important role in your lower kinetic chain, enabling you to walk, run, jump and rebound with forceful power. During walking, the Achilles can handle stress loads of almost four times the body weight, and eight times or more of the body weight during running.

The tendon is formed where the powerful calf muscles, the gastrocnemius and the soleus, merge at the base of the lower leg, connecting them to the heel bone. The Achilles tendon works with the muscles of the calf to plantar flex the foot at the ankle, pointing the toes downward. The Achilles tendon has poor blood supply, mostly coming from the posterior tibial artery.

Symptoms of Achilles Tendinopathy

Achilles tendinopathy typically falls under one of two categories:

• Noninsertional Achilles tendinopathy occurs in the middle portion of the tendon, and is more commonly seen in younger active patients.
• Insertional Achilles tendinopathy occurs where the tendon inserts into the heel bone, and may occur in anyone, even physically inactive people. It is most often associated with long-term overuse in middle-aged runners.

The main symptoms of Achilles tendinopathy are pain felt behind the heel at the back of the ankle when walking or running, and pain and stiffness upon waking after sleep.

Causes of Achilles Tendinopathy

When demands placed on the Achilles tendon exceed its capacity to meet them, tendinopathy occurs. It may result from a single incident of acute trauma, but more often than not, it results from repetitive microtrauma, where the breakdown of tendon tissue worsens over time.

Common underlying causes of Achilles tendinopathy include:

• Tight or weak calf muscles
• Structural or mechanical foot abnormalities
• Ill-fitting, worn or non-supportive footwear
• Sudden change in exercise type, duration, frequency or intensity
• Obesity

Extrinsic risk factors for Achilles tendinopathy may include certain medications, arthritis and metabolic disease.

Diagnosis of Achilles Tendinopathy

During clinical diagnosis, the doctor will examine your foot and ankle and ask questions about your physical activities and the history of your ankle pain. Diagnostic ultrasound may be used to get real-time images of the structures of your foot, to confirm diagnosis, assess the degree of damage, and rule out other causes of your ankle pain.

Treatment for Achilles Tendinopathy

Traditional treatment approaches for Achilles tendiopathy include:

• Rest from physical activity
• Ice to reduce inflammation
• NSAIDs like ibuprofen or naproxen for pain and inflammation
• Corticosteroid injections
• Orthotic shoe inserts or heel lifts
• Athletic taping
• Eccentric loading of the calf muscles
• Stretching

At NYDNR, we design our treatment protocols based on the latest scientific research and evidence. Your individualized treatment plan may include some or all of the following:

• ESWT (extracorporeal shockwave therapy), proven to be one of the best methods to increase blood flow and promote tissue regeneration in the Achilles tendon.
• 3D Video Force Plate/EMG gait analysis and retraining, to identify mechanical deficiencies in walking and running gait that may contribute to Achilles tendinopathy, and correct them.
• CAREN (compter assisted rehabilitation environment): This state-of-the-art virtual reality technology can be used on its own or with other methods to provide progressive treatment of Achilles tendinopathy.
• Training in biomechanics and motor control to eliminate training errors.
• Gradual tendon strengthening.
• Patient education.

Young athletic patients often respond to treatment more quickly than middle-aged adults, with recovery taking about three months for younger patients and up to six months for adults.