Achilles tendonitis is an inflammation of the Achilles Paratendon, which is a sheath that extends over the tendon. It can be painful along the Achilles from the insertion of the Calcaneus to where it joins on to the Soleus, Gastrocnemius muscles (calf muscles).
It occurs more often in sporty people, although it can afflict children and the elderly.
The Achilles can be mildly inflamed or severely swollen.
What causes Achilles tendonitis?
Several biomechanical foot behaviours can be susceptible to the condition.
- The most common type of foot that gets Achilles problems is the high arched foot. This type of foot does not deal well with a tightened calf muscle and the stress can manifest as Achilles tendonitis.
- Women who tend to wear heels, then get into sportswear to jog, are often prone to Achilles issues due to the contrast in heel heights.
- The type where the foot strikes the ground supinated and pronates excessively, leading to excessive bowstringing of the tendon from heel strike to heel lift. The bowstringing causes a friction of the para-tendon leading to inflammation.
Treatment for Achilles tendonitis
- Treatment involves abstinence from the activity that causes the inflammation;
- soft tissue therapy to reduce fibrous scar tissue build-up;
- clear trigger points in the calf muscles.
- Stretching and strengthening exercises as well as Compex neuro-muscular stimulation to aid circulation, reduce pain and increase oxygenation.
- A biomechanical assessment to determine the foot type and the appropriate response to correction.
- Stretching, heel raises and orthotics may be necessary.
- An Achilles night splint can assist in improving calf flexibility overnight, as the calves have the tendency to shorten while sleeping. The reason for this is that the foot is naturally in a flexed down position on sleeping.
- Taping and strapping techniques are often helpful as part of treatment.
I do not recommend Cortisone injections in this area as the Paratendon is poorly vascularised, which is why recovery can be slow. Cortisone can lead to degeneration of the tendon that can lead to a rupture later on.
In severe cases surgery is needed to clear fibrous tissue. Recovery from this is long and one would have to undergo a lengthy rehabilitation with physiotherapy.