Achilles Tendinopathy Explained

The Achilles tendon is the ropy tissue on the back of the heel where the calf muscles meet the heel bone. Repetitive strain of the Achilles tendon can lead to cumulative microtrauma. When the trauma exceeds the tissue’s ability to repair itself, the tendon can become inflamed, leading to localized pain and swelling known as Achilles tendinopathy (1).

Symptoms:

Patients with Achilles tendinopathy may experience stiffness and pain near the Achilles tendon when first getting out of bed in the morning or out of a chair after sitting for a while, pain when touching this area, and sometimes a thickening of the tendon (2).

Risk Factors:

• Risk factors of developing Achilles tendinopathy include having excessively high arches which contribute to poor shock absorption (3).
• Overpronation or excessively low arches are also problematic as that foot type can lead to decreased blood flow to the Achilles and increase the risk for injury (4).
• Training mistakes in active populations can lead to a higher risk for Achilles tendinopathy including abruptly increasing the frequency or mileage of exercise, performing excessive hills training or exercising on hard surfaces (5).  While the majority of those with Achilles tendinopathy symptoms tend to be active and involved with sports, it can also affect inactive populations, most commonly in the 40-59 year old and obese populations (6, 7).

How to Treat Achilles Tendinopathy:

If you have been suffering from Achilles pain on the back of the heel, please call the Weil Foot & Ankle Institute podiatrists.  The Weil podiatrists can offer multiple treatment options that have been shown to alleviate the Achilles tendinopathy symptom.

• Heel lifts in the shoes: Heel lifts are available in the Weil Foot & Ankle offices and can place the foot into a slightly downward angle to reduce Achilles strain with walking (8) and provide immediate pain relief.
• Physical therapy: The Weil physical therapists who specialize in the treatment of foot and ankle conditions design customized programs to relieve Achilles tendinopathy symptoms.  Physical therapy treatment programs may include:
  • Eccentric calf exercise: This is a type of exercise that focuses on activating a muscle as it lengthens.  For example, holding onto a railing, stand on the edge of a stair with the heels hanging off and the forefeet on the stair.  Lift up the heels and weight bear onto the forefeet.  Then super slowly, lower the heels back down.  Research shows that doing this exercise 3×15 times, 2x per day for many weeks can relieve Achilles tendinopathy (8, 9).  A visual presentation of this exercise is available at: https://MSA-PT.medbridgego.com/ using access code: M4J2JACV.  The Weil physical therapists can provide instruction in other eccentric calf exercises to alleviate symptoms.
  • Calf stretching: Calf stretching of the two muscles (gastrocnemius and soleus) that combine to become the Achilles tendon is a staple of physical therapy treatment.  It works to improve calf flexibility and contribute to pain relief (9, 10).  Examples of gastrocnemius and soleus calf stretching are shown on: https://MSA-PT.medbridgego.com/ using access code: M4J2JACV.
  • Soft tissue massage: There is some evidence that massage of the Achilles and calf as well as tool assisted soft tissue work (Graston Technique) are helpful for alleviating Achilles tendinopathy symptoms (11, 12).  Our Weil physical therapists are trained in both traditional soft tissue massage techniques as well as certified in Graston Technique.

• Extracorporeal shock wave therapy (ESWT): This is a non-operative treatment offered in the Weil Foot & Ankle Institute offices.  Several studies have shown that a combination of ESWT and eccentric exercises in physical therapy contributes to significant improvement or complete resolution of Achilles tendinopathy symptoms (1).  ESWT appears to be more effective when the symptoms have been present for less than a year (1) so don’t delay in calling the Weil Foot & Ankle Institute for help.
• Low level laser therapy (LLLT): LLLT is a pain free and fast non-thermal treatment that is offered at the Weil Foot & Ankle Institute’s Mount Prospect clinic.  There is some evidence that LLLT can effectively treat Achilles and other tendinopathies (13) by encouraging cellular repair and affects the vascular and lymphatic systems (14).

The podiatrists at the Weil Foot & Ankle Institute have access to all of these treatments and can help guide their patients towards symptom resolution. If you have been experiencing heel pain, please call the Weil Foot & Ankle Institute. You do not need to continue to suffer.

1. Stania M, Juras G, Chmielewska D, Polak A, et al. Extracorporeal shockwave therapy for Achilles tendinopathy. Biomed Res Int. 2019;2019:3086910.
2. Knapik JJ, Pope. Achilles tendinopathy: pathophysiology, epidemiology, diagnosis, treatment, prevention, and screening. J Spec Oper Med. 2020 Spring;20(1):125-140.
3. Irwin TA. Current concepts review: insertional Achilles tendinopathy. Foot and Ankle International. 2010;31(10):933-939.
4. Karzis K, Kalogeris M, Mandalidis D, Geladas N, et al. The effect of foot overpronation on Achilles tendon blood supply in healthy male subjects. Scand J Med Sports. 2017 Oct;27(10):1114-1121.
5. Murtaugh B, Ihm JM. Eccentric training for the treatment of tendinopathies. Curr Sports Med Rep. 2013 May-June;12(3):175-182.
6. Kujala UM, Sarna S, Kaprio J. Cumulative incidence of Achilles tendon rupture and tendinopathy in male former elite athletes. Clin J Sports Med. 2005 May;15(3):133-135.
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8. Rabusin CL, Menz HB, McClelland JA, Evans AM, et al. Efficacy of heel lifts vs calf muscle eccentric exercise in mid-portion Achilles tendinopathy (the HEALTHY trial): study protocol for randomized trials. J Foot Ankle Res. 2019;12:20.
9. Kedia M, Williams M, Jain L, Barron M et al. The effects of conventional physical therapy and eccentric strengthening for insertional Achilles tendinopathy. Int J Sports Phys Ther. 2014 Aug;9(4):488-497.
10. Park DJ, Chou L. Stretching for prevention of Achilles tendon injuries: a review of the literature. Foot Ankle Int. 2006;27:1086-1095.
11. Ikeda N, Otsuka S, Kawanishi Y, Kawakami Y. Effects of instrument-assisted soft tissue mobilization on musculoskeletal properties. Med Sci Sports Exerc. 2019 Oct;51(10):2166-2172.
12. Carcia CR, Martin RL, Jouch J, Wukich DK. Achilles pain, stiffness, and muscle power deficits: Achilles tendinitis. J Orthop Sports Phys Ther. 2010 Sept;40(9):A1-26.
13. Bjordal JM, Lopes-Martins RAB, Iversen VV. A randomized, placebo controlled trial of low level laser therapy for activated Achilles tendonitis with microdialysis measurement of peritendinous prostaglandin E2 concentrations. Br J Sports Med. 2006 Jan;40(1):76-80.
14. Baltzer AW, Stosch D, Seidel F, Ostapczuk MS. Low level laser therapy: a narrative literature review on the efficacy in the treatment of rheumatic orthopedic conditions. Z Rheumatol. 2017 Nov;76(9):806-812.