Excessive exercise or walking can cause painful inflammation of the Achilles tendon. The Department of Physiotherapy at Singapore General Hospital (SGH) provides more facts on Achilles tendinopathy.
The term 'Achilles tendonitis' is commonly used, which suggests there is some swelling in the Achilles tendon itself. However, recent research studies report that inflammation may not be present in the tendon itself. The inflamed condition may arise due to an unsuccessful healing response in the tendon. Hence, the term tendinopathy is considered to be more appropriate.
Symptoms of Achilles tendinopathy
Pain in the Achilles tendon region may vary with different people. For some, the pain may limit their participation in daily activities. Others may be able to continue with their activities but report latent pain (pain that occurs after exercise or movement or even the next day) instead. You may feel a combination of the following symptoms:
- Pain or tender to the touch over the back of the heel or the region of the Achilles tendon.
- Morning or general stiffness at the back of leg or calf region after lying, sitting or standing for a prolonged period. This may ease off after walking for a few steps or in some cases, walking a longer distance.
Causes and risk factors of Achilles tendinopathy
The exact cause of Achilles tendinopathy is unclear but there are many factors that can lead to Achilles tendinopathy:
- When the tendon is unable to adapt to the load being placed upon it. A sudden overload (e.g. increase in training mileage) may result in microtrauma (tiny injuries) in the tendon.
- Underloading the tendon for a prolonged period may also degrade the quality of the tendon (e.g. abruptly stopping previous daily runs). The tendon may become weak around the area of injury and swelling (due to inflammation occurring in the surrounding structures e.g. bursa ) may or may not be present around the back of the ankle region.
Some factors that can increase the strain placed on the tendon are:
- Advancing age
Other medical conditions e.g. diabetes mellitus, arthritic conditions
Poor ankle and foot range, tight or weak calf muscles, poor ankle stability or weak hip/knee musculature
Foot types – flat foot or high arch foot
Changes in your training regime may also contribute to the stress or underload of the Achilles tendon. These factors include:
- Type of footwear: Improper footwear or any recent change in your footwear may alter your running style
- Training programme (intensity, duration, frequency): Changing the type of your training, excessive increase or sudden decrease in your training mileage, or training grounds
- Your running style
Potential complications of Achilles tendinopathy
In the initial phase when the Achilles tendon is injured, it triggers a healing and recovery process. The injury is reversible in the early phases with proper care or early treatment. However, if there is inadequate rest and injury management, this may affect the healing and recovery of the Achilles tendon. It may eventually develop into a degenerated tendon where the changes are irreversible. Thus, the quality of the tendon becomes affected. The degenerated Achilles tendon (if extensive enough) or if the tendon is placed under high load can rupture.
Read on to find out the diagnosis and types of treatment for Achilles tendinopathy.