Achilles Tendinopathy
The Highlights
Achilles tendinopathy is an overload injury to the achilles tendon experience by both active and non-active people. It results in pain, stiffness and swelling within the tendon.
In our clinic, we can diagnose the type of achilles problem you have (yes, there are several possibilities!) with a thorough clinical examination and, when a definitive diagnosis and highly detailed understanding is required, we can provide on-the-spot diagnostic ultrasound to take a look inside!
Treatment is fundamentally about rebuilding strength and load-tolerance into the tendon through progressively challenging exercises. All other treatment methods are in service of this goal. This includes footwear changes and foot orthoses (specialist insoles).
In addition, as a practice specialising in this condition, we can also offer advanced treatment options including Storz Medical Extracorporeal Shockwave Therapy (ESWT) and High-Volume Image-Guided Injection therapy (HVIGI). Both of which make us unique amongst Podiatry clinics in the Scottish Borders.
What is it and what are the symptoms?
Achilles Tendinopathy is an overload injury where the tendon is not healing/adapting fast enough to keep up with the stresses placed upon on it. The result is a cascade of cellular processes leading to degeneration of the tendon with lowered function and, of course, pain. Side note: Tendinopathy is the more accurate term for this condition and not “tendinitis” as you might have heard it called…now you know!
Symptoms of tendinopathy can vary depending on severity of injury and the length of time you have had it. Common features include pain in the tendon when first moving from a rested position or beginning activity like a run. A lot of people will report the pain eases once they get going. Due to the cellular processes taking place in and around the tendon there can often be swelling and/or a feeling of thickening in the tendon. The pain is usually a dull ache but when aggravated it can feel quite sharp or even burning.
Why does it happen?
As mentioned, Achilles tendinopathy is a classic overload injury - in essence, the amount of mechanical load or stress the achilles tendon can take on a daily basis has been exceeded too many times for it to keep up with heeling and adapting. This often follows a clear "spike" in load - a sudden increase in walking or running mileage, a change in profession (those on their feet a lot for work are particularly prone to this condition), a change in shoes, weight-gain as well as emotional and psychological stresses can all play an important role.
Treatment Options: The Fundamentals
As with all conditions, getting the diagnosis right is paramount and different parts of the achilles tendon require different treatment approaches. First and foremost our team will help you figure out which part is the issue and this may include diagnostic ultrasound imaging to get a better picture of the tendon's overall structural health and help to rule out other conditions such as a bursitis or a systemic inflammatory condition.
Load management (altering how much demand is placed on the injured tissue and how much it can handle) is fundamental to achilles tendon rehab. A lot of the people we see with this problem have had treatment elsewhere which has failed or only given short term relief because it has not properly addressed this fundamental pillar of how tendons recover.
Without stimulation, the tendon has nothing to adapt to and simply will not improve. Our team will guide you through a personalised programme that allows your achilles and it's associated muscles to strengthen and become more resilient to load. This will tend to involve a series of evolutions to your programme as we progressively increase the challenge for the tendon and get you back to normal function.
Treatment Options: Advanced Techniques
All other treatment options centre making tendon loading more achievable. For many patients, foot orthoses (specialised insoles) can be very helpful to address biomechanical factors in your feet and lower limbs and offload the tendon, especially in the short- to medium-term (they are not usually needed in the long-term if the tendon becomes strong enough). Taping has low evidence in achilles tendinopathy research but some patients do find it helpful/reassuring in the short term. In our running clients, we also offer gait retraining programmes to change your running mechanics to put less demand on the tendon whilst allowing you to keep active.
In degenerative tendons with low levels of inflammation, when healing is proving stubborn or not moving fast enough (often an important factor in our sporting patients training for a big event) then we will often recommend Extracorporeal Shockwave Therapy (ESWT). This advanced technology is clinically proven to accelerate healing and reduce pain, and has been approved by the National Institute for Health and Care Excellence (NICE). Read more about ESWT here.
In more inflammatory midportion tendon issues (a few cm above it’s insertion on the heel bone) which is most common, we can offer an advance procedure called high-volume image-guided injection therapy (HVIGI). This is especially helpful when “neovascularisation” is present. This is an excessive growth of blood vessels and nerve fibres into the tendon causing pain (something we can determine with our ultrasound technology right from your first appointment). We are exceptionally proud to be the first and only clinic in the Scottish Borders to offer this powerful treatment option which you can read more about here.
