Achilles Tendinopathy

What is Achilles Tendinopathy?

Achilles tendinopathy is a condition that affects the Achilles tendon, which is the large tendon connecting your calf muscles to your heel bone. This condition occurs when the tendon becomes irritated, inflamed, or degenerates due to overuse or injury. It can cause pain, stiffness, and reduced function in the affected area.

At Willoughby Health, our team of Physiotherapists and Chiropractors often see patients with Achilles tendinopathy. We understand how this condition can affect your daily activities and quality of life, and have put together this guide to help you better understand this condition.

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What are the different types of Achilles Tendinopathy?

There are two main types of Achilles tendinopathy:

• Insertional Achilles Tendinopathy: This affects the lower part of the tendon where it attaches to the heel bone.
• Mid-portion Achilles Tendinopathy: This affects the middle portion of the tendon, typically 2-6 cm above the heel.

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What are the symptoms of Achilles Tendinopathy?

The symptoms of Achilles tendinopathy can vary, but common signs include:

• Pain and stiffness along the Achilles tendon, especially in the morning
• Pain that worsens with activity, particularly running or jumping
• Swelling or thickening of the tendon
• Tenderness when squeezing the sides of the tendon
• A crackling sound (crepitus) when moving the ankle
• Difficulty climbing stairs or standing on tiptoes
• Pain at the back of the heel
• Reduced strength and flexibility in the ankle

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What causes Achilles Tendinopathy?

Achilles tendinopathy is usually caused by repetitive stress on the tendon. Some common causes include:

• Overuse from high-impact activities like running or jumping
• Sudden increase in training intensity or duration
• Poor footwear that doesn't provide adequate support
• Tight calf muscles that put extra strain on the tendon
• Abnormal foot structure, such as flat feet or high arches
• Obesity, which puts extra stress on the tendon
• Certain medications, like some antibiotics, that can weaken tendons

Our Physios and Chiros in Willoughby can help you identify what might be causing your Achilles tendinopathy and develop a treatment plan to address these factors.

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How is Achilles Tendinopathy diagnosed?

When you visit Willoughby Health with symptoms of Achilles tendinopathy, our Physiotherapists and Chiropractors will use several methods to help diagnose your condition:

• Medical history: They'll ask about your symptoms, when they started, and how they affect your daily life.
• Physical examination: Your Physiotherapist or Chiropractor will:
  • Check for swelling, tenderness, and thickening of the tendon
  • Assess your ankle's range of motion
  • Test your calf and ankle muscle strength
  • Observe your gait (how you walk)
  • Specific tests: They might perform tests like squeezing the tendon or jumping and hopping tests to try reproduce the pain.
• Imaging tests: In some cases, ultrasound or MRI scans may be recommended to get a closer look at your tendon.

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Do I need any scans for Achilles Tendinopathy?

While Achilles tendinopathy is often diagnosed through physical examination, imaging tests can be helpful in some cases:

• Ultrasound: This can show thickening, inflammation, or small tears in the tendon.
• MRI (Magnetic Resonance Imaging): This gives a detailed view of the tendon and can show more subtle changes or rule out other conditions.
• X-rays: These aren't typically used to diagnose Achilles tendinopathy, but they might be recommended to rule out other conditions like heel spurs.

At Willoughby Health, our Physiotherapists and Chiropractors can refer you for these scans if necessary and explain what the results mean for your condition and treatment.

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How is Achilles Tendinopathy treated?

Treatment for Achilles tendinopathy aims to reduce pain, improve tendon function, and prevent future problems. At Willoughby Health, we offer a range of treatments, including:

• Rest and activity modification: Reducing activities that aggravate your symptoms
• Exercise therapy: Our team can design an exercise program to strengthen your calf muscles and improve tendon function
• Heel wedges: To reduce stress on the tendon
• Ice therapy: To reduce pain and inflammation
• Pain relief: Over-the-counter pain medications may be recommended
• Shockwave therapy: To stimulate healing in the tendon
• Injections: In some cases, certain types of injections might be used
• Surgery: In severe cases that don't respond to other treatments

Our Physios and Chiros in Willoughby will work with you to create a treatment plan tailored to you, so you can get back walking normally again, running, work, or playing sports.

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How do heel wedges help with Achilles Tendinopathy?

Heel wedges are inserts that you place in your shoes to lift your heel. They can help with Achilles tendinopathy by:

• Reducing the stretch on your Achilles tendon
• Decreasing the load on the tendon during activities
• Providing pain relief

While heel wedges can be helpful, they're typically used as a temporary measure alongside other treatments.

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When injections are used for Achilles Tendinopathy?

Injections are sometimes used to treat Achilles tendinopathy when other conservative treatments haven't provided enough relief. Types of injections may include:

• Corticosteroid injections: These are used less commonly now due to the risk of tendon rupture
• Platelet-rich plasma (PRP) injections: These use components of your own blood to potentially stimulate healing
• High-volume injections: These aim to break up scar tissue and stimulate healing

It's important to note that the effectiveness of injections for Achilles tendinopathy is still being researched. At Willoughby Health, our team can discuss whether injections might be appropriate for your condition, and recommend some good Sport and Exercise Medicine Physicians and imaging centres to get them done at.

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Can shockwave therapy help Achilles Tendinopathy?

Shockwave therapy, also known as Extracorporeal Shock Wave Therapy (ESWT), is a non-invasive treatment that uses pressure waves to stimulate healing in the affected tendon. It can help by:

1. Increasing blood flow to the area
2. Stimulating the production of collagen, which is important for tendon health
3. Breaking down scar tissue
4. Reducing pain

At Willoughby Health, we offer shockwave therapy as one of our treatment options for Achilles tendinopathy. Our Physiotherapists and Chiropractors can assess whether this treatment might be suitable for you.

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Is surgery required for Achilles Tendinopathy?

Surgery for Achilles tendinopathy is generally only considered when:

• Conservative treatments haven't improved your symptoms after 3-6 months
• Your pain is severe and significantly affects your quality of life
• There's significant damage to the tendon

Surgical options may include:

• Debridement and repair: Removing damaged tendon tissue and repairing the remaining tendon
• Tendon transfer: Using another tendon to augment or replace the damaged Achilles tendon

If surgery is being considered, our team can help recommend some good orthopaedic surgeons that can perform this procedure, as well as guide you through the rehabilitation process after any surgeries.

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How does exercise help treat Achilles Tendinopathy?

Exercise is a crucial part of treating and preventing Achilles tendinopathy. It helps to:

1. Strengthen the calf muscles and Achilles tendon
2. Improve flexibility in the ankle and calf
3. Enhance the tendon's ability to handle load
4. Promote proper movement patterns

Our Physiotherapists and Chiropractors at Willoughby Health can design an exercise program tailored to your specific needs. This might include:

1. Eccentric calf raises: Lowering your heel slowly from a raised position
2. Isometric exercises: Holding your calf muscles in a contracted position
3. Stretching exercises for your calf muscles
4. Balance and proprioception exercises

Remember, it's important to start gently and gradually increase the intensity of your exercises. Our team will guide you through this process safely.

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Can I prevent Achilles Tendinopathy?

While you can't prevent all cases of Achilles tendinopathy, there are steps you can take to reduce your risk or prevent it from worsening:

• Gradually increase your activity levels: Avoid sudden increases in exercise intensity or duration
• Warm up properly before exercise: This helps prepare your muscles and tendons for activity
• Wear appropriate footwear: Choose shoes that provide good support and cushioning
• Maintain a healthy weight: Excess weight puts more stress on your tendons
• Stretch and strengthen your calf muscles regularly
• Cross-train with low-impact activities: Mix high-impact activities with lower-impact ones like swimming or cycling
• Listen to your body: If you feel pain, stop the activity and rest

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When should I see someone about Achilles pain?

You should consider seeing a healthcare professional if:

• You have persistent pain in your heel or along your Achilles tendon
• Your pain is affecting your daily activities or sleep
• You're having difficulty walking or standing on your toes
• You notice swelling or thickening in your Achilles tendon
• You've tried home remedies without success

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Take home message

Achilles tendinopathy is a common condition that can significantly impact your mobility and quality of life. However, with proper diagnosis and treatment, most people with Achilles tendinopathy can find relief and improve their tendon health.

At Willoughby Health, our team of experienced Physiotherapists and Chiropractors in Willoughby can help you manage and recover from Achilles tendinopathy. We offer a range of treatments and can provide personalised advice on exercises, lifestyle modifications, and strategies to prevent recurrence. Remember, early intervention is key in managing Achilles tendinopathy.

If you're experiencing persistent heel or ankle pain, don't hesitate to contact us. We have clinics conveniently located in Mt Kuring-Gai, Asquith, Milsons Point, Dural, and Blacktown, so you can get the right advice and treatment for your Achilles tendinopathy.