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Achilles Tendonitis

Definition

Achilles tendonitis is a repetitive strain injury involving lower leg muscles and tendons and their point of attachment to bones. It is typically characterized by tight gastrocnemius and soleus (posterior) muscles/tendons and typically weak tibialis anterior and extensor hallucis and digitorum longus (anterior) muscles/tendons.

Cause

Achilles tendon injuries can be caused by: overuse, misalignment, improper footwear, medication side effects, and/or accidents. Multiple causes often contribute to the same Achilles tendon injury. For example: a sudden increase in hill climbing, worn out shoes, and weak or tight calf muscles could all contribute to Achilles tendinitis and Achilles tendonitis.

Achilles tendonitis is a chronic injury that occurs primarily from overuse. It tends to come on gradually over time until pain is constant and exercise or activity too painful to continue. The biggest cause of chronic Achilles tendonitis is ignoring early warning signs and pushing through pain. If the Achilles tendon is sore, or aches, you need to pay attention and rest it immediately.

Another major contributor in the development of Achilles tendonitis is lack of flexibility in the calf muscles, which cause the muscle to shorten which creates more tension in the tendon. Overuse can also contribute to Achilles tendonitis as can a sudden increase in training mileage, hill running or a lot of speed work. The Achilles tendon has a limited blood supply, which makes this injury slow to heal. Early recognition of any tension, aches or tenderness is the most important aspect of treating tendon injuries.

Treatment and Prevention

Treatment

Treatment protocols depend on factors such as severity of the injury, time in the competitive season, and the previous injury history of the athlete. Initially, rest or modification of activity is necessary to protect the Achilles tendon from further injury. A heel lift in the athlete’s shoe is commonly used to alleviate stress on the Achilles tendon.

There are several therapeutic modalities available that can reduce the pain and swelling associated with tendinitis. Ultrasound, iontophoresis, and ice massage are all effective.

Once tolerated, ranges of motion exercises are necessary to regain normal mechanics of the lower leg and ankle. Passive stretching of both gastrocnemius and soleus is essential. Stretching should be done with the affected leg placed slightly behind the other, keep the heel on the ground, and then lean forward. It is helpful to use a wall for balance. This stretch should be done both with the knee straight and then again with the knee bent to stretch all of the muscles of the calf. Stretches should be held for 10 seconds, 10 repetitions, and done two to three times a day.

Prevention:

If you’re just getting started with your training, be sure to stretch after running, and start slowly, increasing your mileage by no more than 10% per week. Strengthen your calf muscles with exercises such as toe raises. Work low-impact cross-training activities, such as cycling and swimming, into your training.

There are anatomical factors that have been identified as contributors to Achilles tendinitis. Many individuals with Achilles tendinitis have limited calf and hamstring flexibility. Fortunately, these issues can be addressed through a good stretching program. Structural problems in the lower leg may increase stress on the Achilles tendon.

Examples would be problems commonly known as “knock knees”, “bowlegs”, and flat feet. Referral to a sports medicine physician or podiatrist may be helpful to determine if orthotics would be appropriate in order to promote better foot mechanics.

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