Pathophysiology

The achilles tendon attaches to the calcaneous bone at the heel and divides into the calf muscles, allowing us to point our toes and is particularly important in walking or climbing stairs. The achilles can become overloaded with a sudden change in activity causing a reactive tendinopathy or degenerative. The location of irritation can either be at the insertion of the tendon to bone or in the middle of the tendon, depending on this the treatment varies slightly.

Symptoms

• Pain directly over the achilles tendon, tender to touch
• May be swollen
• Pain and stiffness for under 30 minutes on waking in the morning which improves with movement
• Pain tends to be worse after activity and this may last 24 hours after a flare up
• Pain on walking, running or stairs
• Pain with footwear which compresses the tendon

Management

• Activity modification
• Ice or heat
• Pain relief
• Appropriate footwear which provides support and doesn’t rub on the tendon
• Orthotics
• Weight loss if overweight or obese (most people will notice an improvement in joint pain and function after losing 5% of their body weight)
• Physiotherapy including range of movement exercises and a graded strengthening programme
• Orthopaedic options- If pain and functional limitation is significant after 3-6 months of conservative measures may be considered

Investigations

Generally not indicated, ultrasound can assess level of tendon swelling and x-ray can assess for foot deformity

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