Achilles tendon pain

The Achilles tendon is a combined tendon of the two muscles in the calf, the larger muscle being Gastrocnemius and smaller muscle being Soleus.  This tendon is the strongest tendon in the body, it can still become overloaded or suffer from overuse resulting in pain and discomfort.

What causes Achilles pain?

This is caused by a condition call Achilles Tendinopathy (previously called Achilles tendonitis as it is now known that the Achilles does not inflame).  The condition is typically seen in running and jumping type activities and does develop in those who do not play sport.  The incidence of increased tightness can increase during the summer months as people are more inclined to wear flat sandals / flip-flops for longer periods and this type of footwear results in a longer stretch being applied to the Achilles tendon which can result in developing tendinopathy. 

As the tendon becomes overloaded it often becomes thicker in the middle of the tendon just above (approx 5 cm above) where the Achilles tendon inserts in to the heel bone.  It will feel tight and sore first thing in the morning or when starting exercise.  Pain may also start during exercise as the tendon tires and will often continue even after stopping the activity.

Insertional Achilles Pain

This is more complex and can be related to a number of influencing factors including tendinopathy, inflammation of bursa and pressure from the heel bone. You would require advice from a Physiotherapist or Podiatrist to help improve the condition so if your pain is more pinpoint to where the Achilles tendon actual inserts into the heel bone please contact your doctor

Inflammation

As previously stated the Achilles tendon does not become inflamed but very occasionally the outside sheath of the tendon can become inflamed. Swelling will be diffuse and associated with a crunchy feeling (crepitus) when touched.  This condition is rare and if you suspect you have it then please contact your doctor

How do I treat Achilles tendinopathy?

The tendon is painful and thickened, this occurrs because it is too weak to cope with the loads placed upon it.  As weakness is already part of the problem, absolute rest is only going to make the problem worse by contributing to the weakness, but you should consider trying to avoid activities that bring on the pain.    Achilles pain responds well to a simple heel drop exercise which in many cases resolves the problem.  The exercise will be painful at first and should be carried out each day with the expectation that you will need to do this exercise for up to 3 months.  The exercise can be seen above on the plantar fasciitis exercise sheet with the exception of the bottle rolling exercise.

If every day working is causing you Achilles pain you may wish to consider wearing a shoe with a small heel or a small heel raise in your shoe to reduce the stretch the tendon is experiencing.  This alone will not resolve pain and must be done in conjunction with the stretching exercise.

Please ss the video to demonstrate planter fasciitis and Achilles tendon pain exercises.

It is ok to take simple painkillers such as paracetamol as required, particularly during the first couple of weeks of completing the exercises

Prevention

Prevention is always better that cure so continue to do your strengthening and stretching exercise on a regular basis and not just when the symptoms reoccur and review your foot wear regularly

Ankle Sprain

Ankle sprains can happy to any of us at any time and usually involve a sprain to one the ligaments in the image below.  The most common mechanism of injury involves going over on the ankle such as when slip off a step, stumble on uneven ground or when shoes with a high heel.  Most simple sprains will resolve in 2 to 4 weeks.

How can I manage / treat my ankle sprain?

  • Protect the ankle by not exposing it to the same activity that caused the injury
  • Rest. This should be relative not absolute. Maintain your range of movement and do not confine yourself to bed
  • Ice – use ice packs for up to 20 minutes every 2 – 3 hours that you are awake
  • Compression – if you have access to some tubi-grip of the correct size use it
  • Elevation – when resting try elevating the knee slightly up on a pillow length ways so it is above the height of the hip
  • Drugs – painkillers such as paracetamol provide good relief. Debate remains on the use of anti-inflammatory drugs in the first 48 hours as although all these steps are designed to control swelling/inflammation some swelling is still required as this is the body's injury response mechanism, so it may delay the overall healing process in the longer term

After the first 48 hours

  • Stretch the calf muscle – with your leg straight place a towel around the ball of the foot and gently pull your foot towards you until you feel a stretch in the calf. Hold this for 20 seconds and repeat.  Aim to build up to repeating this 20 times per day
  • When you can comfortably weight bear on the injured ankle stand facing a wall. Take a step backwards with the injured leg, rest your hand upon the wall and push your hips slowly forward until you feel a stretch in the calf. Hold for 20 seconds.  Do this 10 times twice a day (you may need to build this up)
  • Maintain your ankle range of movement by writing the alphabet using your big toe.  Write the entire alphabet twice a day
  • Strengthening – it is important to strengthen the muscles that turn the ankle outwards as these will support the sprained ligaments.  You will need a looped piece of elastic fitness band. Place both feet in the loop and, using your injured foot, turn your foot outwards against the resistance and return to the starting position. Build up to complete 3 sets of 10 twice a day
  • Balance training – this will help prevent sprains in the future. Stand next to a stable object such as table or kitchen counter and hold on for support when starting to balance on the injured foot/ankle.  Stand and balance on the injured leg and build up to do 3 sets of 1 minute balances twice a day.  Once confident try this same exercise standing on a cushion.  Once you have achieved this go back to balancing on the floor but this time with your eyes closed.

For demonstrations of these exercises please see video

Footwear

We all need a variety of footwear for different activities but we so often get it wrong resulting in inappropriate or incorrect fitting shoes, contributing to the development of many foot and ankle conditions.  Please see footwear advice information below from the Society of Chiropodists and Podiatrists.

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