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Achilles Tendinitis Rehabilitation

• • R.I.C.E
  • Home Exercises and stretches to help recover from Achilles Tendinitis
  • Surgery for Achilles Tendinitis

When should I see a Podiatrist?

Step Ahead Podiatry Clinic

Achilles Tendinitis Vs Achilles Tendonitis Vs Achilles Tendinosis

We should first address the terms Tendonitis Vs Tendinitis Vs Tendinosis.

• Tendinitis – The section ‘itis’ is Latin for inflammation, and you see it added to the end of many other medical terms to denote inflammation of the body part that is being affected. Achilles Tendinitis is the proper term that is used when describing this specific medical condition. 
• Tendonitis – It is understandable when the condition is located on a tendon spelt with an ‘o’ to think that is the correct spelling, but tendonitis is actually incorrect. Although, over time this mistake has become interchangeable with tendinitis in a more casual way when specificity is not so necessary. So, if you see both terms used, you do not need to worry if it is a different condition.
• Tendinosis – Our understanding of how the body works is an ever-evolving process of scientific research, and tendinosis is a product of the knowledge around tendons becoming more nuanced. Tendinosis is a term used for tendons that are suffering from degeneration rather than inflammation. This knowledge has been around since the 70’s but is still confused with tendinitis as the symptoms are the same, or only used when needed to be medically specific. Having tendinosis does not mean that you will not have inflammation though, it is still a part of the body’s healing process. It will just not be the primary cause.

In the end, the symptoms are the same and your podiatrist will be able to get to the bottom of which is the cause to plan treatment and rehabilitation accordingly. 

Achilles Tendinopathy, what is the difference?

Now, tendinopathy is a relatively new term. As I explained, ‘itis’ means inflammation, and if there is a tendon issue but it’s not due to inflammation, then calling it by the ‘itis’ suffix is technically incorrect.

This is where tendinopathy has been coined to describe conditions with almost identical symptoms, but from different possible causes other than inflammation (yet can still include tendinitis) because it is an umbrella term for tendon dysfunction and pain, no matter the clinical cause.

Usually, these other causes would be something like micro tears or degeneration (this is tendinosis). 

As the medical knowledge of tendons expands and we are finding that it is not all about inflammation, we need new terms to encompass all possible causes. This is tendinopathy as a broader term to encompass all these various conditions.

OK, now that is out of the way, let’s get into what is the medical condition, Achilles Tendinitis!

What is Achilles Tendinitis?

Symptoms of Achilles Tendinitis

To fully understand what condition the symptoms you are experiencing are from will require a professional to assess your recent activities, medical history, and ongoing symptoms. But here are a few of the common symptoms you can encounter with the condition Achilles Tendinitis: 

• Stiffness in the morning: This is a common complaint, as the tendon tightens up overnight. You might feel it loosen up somewhat as you move around throughout the day.
• Tenderness: The Achilles tendon will likely be sore to the touch, especially along its length and around the heel.
• Decreased ability to bear weight: Pain can make it difficult to put your full weight on the affected heel, and walking or standing for extended periods may be uncomfortable.
• Pain: You’ll likely experience pain in the back of your heel and along the tendon, especially with activity. It might be worse when pushing off with your toes.
• Problem extending the foot: Achilles tendinitis can make it difficult to point your toes downward due to tightness and pain in the tendon. This can affect your balance and ability to rise up on your tiptoes.
• Swelling: There can be a noticeable swelling of an area of the Achilles tendon on the back of the heel that creates a lump.
• Pain the day after exercise: Sometimes you may not experience too much discomfort until the next day after exercising, when the pain will be quite severe.

Causes of Achilles Tendinitis

There can be quite a few contributing conditions and factors that can negatively affect tendons, such as smoking, abdominal obesity, gout, rheumatoid arthritis, and also type 2 diabetes. Some medications have also been found to be factors in risk for Achilles tendinitis, such as statins, steroids, and fluoroquinolones which are common antibiotics for treating infections.

Excessive exercise or a sudden increase in load for your weight training can be a factor leading to Achilles tendon injuries.

Sports with the most risk for Achilles Tendinitis

Sports that involve repetitive jumping, forceful pushing off, and sudden changes in direction put the most stress on the Achilles tendon and are most likely to cause Achilles tendonitis. Here’s a breakdown by sport type:

High-Risk Sports:

• Running: Long-distance running, especially on hills or hard surfaces, and sprinting with frequent starts and stops can all place significant stress on the Achilles tendon.
• Jumping Sports: Basketball, volleyball, and high jump all involve explosive jumping movements that put a high strain on the Achilles tendon.
• Racket Sports: Tennis and squash require quick changes of direction and forceful pushing off, which can irritate the tendon.
• Dancing: Ballet and other forms of dance that involve a lot of jumping and leaping can be risky for Achilles tendonitis.

Moderate-Risk Sports:

• Football (Soccer): While not as high-risk as jumping sports, football can still put stress on the Achilles tendon due to the running and kicking involved.
• Baseball/Softball: Sprinting and sudden stops to change direction can increase Achilles tendon strain, especially for pitchers who generate a lot of force with their push-off.

Lower-Risk Sports:

• Swimming: This is a low-impact exercise that doesn’t put significant stress on the Achilles tendon.
• Cycling: Cycling is another low-impact option that is generally safe for those with Achilles tendonitis. However, it’s important to ensure proper bike fit to avoid any unnecessary strain on the ankles.

Remember: Even in lower-risk sports, improper training techniques, sudden increases in intensity, and not warming up properly can all contribute to Achilles tendonitis. It’s important to listen to your body, gradually increase the intensity, and prioritise proper form to minimise risk.

Pronation and Supination of the Foot

Pronation and supination are the natural inward and outward rolling motions of your foot during walking and running. While some pronation is normal, excessive amounts in either direction can put stress on the Achilles tendon and increase the risk of Achilles tendonitis. As you can see with how the tendon works in providing power to vertical movement, shearing stress from a horizontal direction is not something that the tendon can manage well.

Here’s a breakdown of how pronation and supination affect Achilles tendonitis risk:

Orthotics can play a role in managing pronation and reducing Achilles tendonitis risk:

• Overpronation: Orthotics with arch support can help control excessive inward rolling and stabilise the foot. This reduces the strain on the Achilles tendon and promotes proper alignment.

• Supination: Orthotics with a lateral post (outer arch support) can help guide the foot inward slightly, correcting the outward rolling and promoting better alignment for the Achilles tendon.

It’s important to note that orthotics should be prescribed by a podiatrist after a proper evaluation of your gait and foot type. They can assess your pronation pattern and recommend the most suitable orthotics for your needs.

If you think you may have a pronation or supination issue, feel free to contact us or book an appointment online so we can assess your gait and let you know if there is an issue.

Achilles Tendinitis treatment can be frustrating and prolonged if direction from your podiatrist is not followed, and the Achilles tendon is overloaded from too much training too soon.

For rehabilitation from Achilles tendon injuries, it requires that you find the sweet spot for your injury recovery. This is done by listening to your body and pain levels after training. With everything in life, it’s about balance, and having too much rest or too much physical activity can both be a problem in your recovery.

If you rest for a long period and the symptoms lessen, then go straight into your old training regime straight away, you will more than likely cause overloading and be back where you started or worse. The tendon needs to be conditioned with load training to work back up to those levels of physical activity.

Once you start strengthening exercises on your Achilles tendon you will get slight pain during training (of course stop if pain becomes too much), but this is not the factor that should dictate your load levels. The pain you experience the next day is actually more of a sign of how the tendon is responding and if the load was too high. Often people will choose to ‘push through the pain‘ and continue again with the exercise that you did the day before, which could end up overloading the tendon again and losing all the recovery you have made already.

If you experience pain the next day, then rest up for a while and try again when symptoms lessen. You will eventually see progressive growth and adaptation of your tendon strength over time which will lead to a healthier tendon for when you fully recover. You may even fill in some of the rest time with lighter less strenuous exercises like cycling or swimming after putting your Achilles tendon through a long run.

R.I.C.E

You may have seen this before, but it is a good acronym to remember:

• Rest – Minimise activities that aggravate the Achilles tendon. This might involve switching to low-impact exercises like swimming or cycling or using crutches for a short period.
• Ice – Apply ice packs to the affected area for 15-20 minutes at a time, wrapped in a thin towel to prevent skin irritation. Do this several times a day, especially after activities that cause pain.
• Compression – Wear a compression bandage or sock to help reduce swelling and inflammation. Ensure that it’s snug but not so tight as to restrict circulation.
• Elevation – Prop your foot up above your heart level whenever possible, especially when resting or sleeping. This helps reduce swelling by promoting drainage of fluids.

Night Splint

Night splints aim to keep your ankle in a dorsiflexed position (foot pointed upwards) throughout the night. This gentle stretch may help reduce stiffness and pain in the morning, especially for those who experience significant stiffness upon waking.

Studies on the effectiveness of night splints for Achilles tendonitis are mixed. Some show potential benefits, while others show no significant difference compared to other treatments. It’s best to discuss night splints with our podiatrist. They can assess your individual situation and determine if night splints could be a helpful addition to your overall treatment plan.

Footwear 

It could be found that your footwear was a major factor in how your condition came about and it is now necessary to have footwear that can properly support your foot and ankle in the areas it needs. This may also include the inclusion of custom or prefabricated orthotic inserts. Book an appointment with us to assess your gait and give you the information you need to get the perfect footwear!

Home Exercises and stretches to help recover from Achilles Tendinitis

Make sure to get a plan from your podiatrist or physical therapist and only do these stretches and exercises if they give the ok for your condition.

The aim is to increase the ankle and foot’s range of motion, along with giving a minimal load to progressively increase slowly as you recover. It is best not to go straight into stretching and exercising while you are still in the early days of pain and swelling, let this recover a little bit and test tentatively what you can handle after some rest. If there is still substantial tendon pain, let your podiatrist or physical therapist know so they can guide you on what to do.

Home Stretches:

• Calf Stretch: Stand facing a wall, arms shoulder-width apart, hands flat on the wall. Extend one leg back with the heel flat on the floor, keeping the front knee straight. Lean forward until you feel a stretch in the calf of the back leg. Hold for 10-20 seconds, repeat 2-3 times per leg.
• Seated Calf Stretch: Sit on the floor with both legs extended. Loop a towel around the ball of one foot and gently pull back towards you until you feel a stretch in the calf. Hold for 10-20 seconds, repeat 2-3 times per leg.

Home Exercises:

Wall Sit: 

1. Find a clear wall: Stand with your back flat against a wall, feet shoulder-width apart.
2. Slide down: Slowly slide your body down the wall until your knees are bent at a 90-degree angle (like a sitting position). Your thighs should be parallel to the floor as much as possible.
3. Engage your core: Keep your core muscles engaged to maintain good posture throughout the hold.
4. Hold the position: Hold this squat-like position for 15-30 seconds, focusing on a slight isometric contraction in your calf muscles. You should feel a gentle engagement in the calves without any movement.
5. Slowly stand up: After the hold, slowly press through your heels to stand back up straight.

Heel Lift & Drops: Stand on a step with the balls of your feet on the edge and heels hanging off. Slowly lower your heels down below the step, then use your unaffected leg to push back up. Focus on controlling the downward movement. Repeat 10-15 times, 2-3 sets. This exercise is particularly beneficial for strengthening the calf muscle in a lengthened position, which is important for Achilles tendon health.

Remember this is a general guideline. It’s important to consult with a podiatrist or physical therapist before starting any new exercise program, especially if you have Achilles tendonitis. At Step Ahead Podiatry we can assess your situation and provide personalised instructions based on your needs and recovery stage.

Brisement

We wanted to cover this controversial treatment, even though it is not one we administer or have seen administered.

It falls under the category of Prolotherapy which can be characterised as an alternative medicine and has yet to prove itself as a treatment with enough evidence-based research to become more mainstream. Some studies have found little evidence of brisement being any more effective than traditional eccentric exercises in the treatment of Achilles tendinopathy.

Brisement is a procedure involving injecting a small amount of fluid, typically sterile saline solution, into the space between the tendon and its surrounding sheath. The basic premise is to introduce an agitating solution to trigger more inflammation. The theory being that by doing this it will give pain relief and provide rapid healing.

This procedure is not something that we practice, but it is good to mention so that we can help people make informed decisions about their treatment options.

Surgery for Achilles Tendinitis

Surgery for Achilles tendonitis is usually a last resort after non-surgical treatments haven’t provided relief. Here’s a summary of when surgery might be considered and the different types:

Depending on the nature of your Achilles tendinitis, you may fall into one of these specific procedures:

• Tendon repair: For a complete tear, the surgeon will suture the torn ends of the tendon back together.
• Debridement: If degeneration is the main issue, the surgeon may remove inflamed or damaged portions of the tendon to promote healing.
• Tendon lengthening: In some cases, the calf muscle might be too tight, pulling excessively on the tendon. Surgery might involve lengthening the calf muscle to relieve tension in the Achilles tendon.
• Tendon transfer: In rare cases with severe damage, a tendon from another part of the foot might be used to reinforce or replace a portion of the Achilles tendon.

Make sure to discuss all options with your podiatrist and doctor before surgery. They can assess your specific situation, explain the risks and benefits of surgery, and determine if it’s the right course of action for you, this should be a last resort.

When should I see a Podiatrist?

Achilles tendon pain is the main reason to contact your podiatrist. Any persistent pain in your feet or ankles, especially if it affects your ability to walk or participate in activities, warrants a visit.

Step Ahead Podiatry Clinic

If you think that you may have this condition (or another) and want some friendly expert advice and treatment, please feel free to contact us a Step Ahead Podiatry.

Step Ahead Podiatry is located in Mount Eliza, along the Mornington Peninsula of Victoria. 

We are ready to take your enquiries for a consultation on 03 9708 8626 or you can find our contact form on our Contact Us page if you prefer written communication.