Achilles Tendon & Heel Pain.png — Achilles tendon pain. Types of issues, causes, symptoms & how Osteopaths treat & manage it

Anatomy of the Achilles tendon, and what does it do?

The Achilles tendon is a fibrous band that connects the heel to the calf muscle, which is comprised of the soleus and gastrocnemius muscles forming the gastroc-soleus muscle group. 💪🏼

When they contract, they pull on the Achilles tendon, causing your foot to point down and helping you rise on your toes. This powerful muscle group helps when you sprint, jump, or climb. Several different problems can occur that affect the Achilles tendon, some rather minor and some quite severe.

Achilles Tendon Problems

Achilles Tendon Pain

The Achilles tendon can be affected by various conditions, such as tendonitis, tendinopathy, tendocalcaneal bursitis, and tendonosis. The following conditions will be defined and elucidated. Athletes, particularly those participating in running, basketball and jumping sports, tend to experience these issues more frequently. 🤓

These conditions are prevalent among middle-aged adults who are both active or sedentary (inactive) . These problems cause pain at the back of the calf or heel. Severe cases may result in a rupture of the Achilles tendon.

Tendocalcaneal Bursitis

Bursae are sac-like structures filled with fluid that reduce friction between rubbing parts. Bursitis occurs when a bursa becomes inflamed. Tendocalcaneal bursitis is the inflammation of the bursa behind the heel bone. This bursa limits friction where the Achilles tendon glides up and down behind the heel.

Achilles Tendonitis

Trauma to the calf muscles or Achilles tendon can result from recurrent micro strains / tears, also known as tendonitis. This injury often occurs during intense muscle contractions, such as running or sprinting. Jumping and landing on the ground can also cause injury by forcing the foot upward. The strain may affect different parts of the muscles or tendon, including the centre of the muscle or where it joins the Achilles tendon (musculotendinous junction).

Achilles Tendinopathy / Tendinosis

Overuse can cause alterations in the Achilles tendon, resulting in its degeneration and thickening. Research indicates the absence of inflammation in tendon overuse injuries. Therefore, experts commonly use terms such as tendinopathy or tendinosis instead of tendonitis to describe this condition.

Achilles Tendon Rupture

In cases of severe strain, the tendon may rupture. This often occurs in middle-aged individuals who participate in high-impact activities like tennis. Prior to the rupture, the tendon may become weakened due to tendinopathy or tendinosis. 💥

Osteopathy Northern Beaches — Tendinitis, tendinopathy / tendinosis, tendocalcaneal bursitis, or rupture? 🔥

Causes of Achilles Tendon Pain

Overuse - Individuals who engage in excessive training may experience overuse injuries, particularly disorders affecting the Achilles tendon. Runners and those who participate in sports involving frequent jumping, such as basketball, are especially vulnerable to these types of injuries.

Structural and functional foot Issues - Excessive pronation (flattening of the arch) can cause foot problems. This puts greater demands on the Achilles tendon when walking. The flattened arch pulls on calf muscles and keeps the Achilles tendon under tight strain. This constant mechanical stress can cause inflammation, pain, and swelling of the tendon. Being overweight can make the problem worse.

Incorrect footwear - Improperly fitting footwear can cause additional stress and instability to the feet during physical activity, increasing the risk of injury. Wearing heels frequently can cause the Achilles tendon to shorten, which can lead to injury when flat shoes are worn during exercise.

Signs & Symptoms

The most frequently reported symptom is pain in the lower leg or back of the ankle, typically in close proximity to the heel.

Typically, pain tends to be more intense in the morning as weight is applied to the foot.
Symptoms of tenderness, redness, and warmth may be present in the affected area.
There is a decrease in ankle mobility.
Symptoms of pain and stiffness may occur after periods of inactivity of the calf muscles, such as prolonged sitting or after sleeping.
Inflammation and pain may occur after overuse of the calf muscles, such as during activities like walking, running, or jumping.
Symptoms of tendocalcaneal bursitis include pain and irritation at the back of the heel, along with redness and swelling in the affected area. Shoe wear may exacerbate the condition.
An Achilles tendon rupture is typically identifiable as bystanders may hear a snap and the victim will feel a sensation similar to a forceful kick to the calf. After the rupture, the calf may become swollen and the individual will likely be unable to lift onto their toes.

Osteo Treatment & Management

During your consultation with an osteopath, a thorough medical history and physical examination will be conducted to assess the injury and determine an appropriate treatment & management plan for your achilles tendon injury / condition. 👩🏼‍⚕️

The examination may focus on your back, pelvis, legs, and a few other body regions to determine areas of abnormality (i.e. instability & weakness) and if your walking or running cycle is loading your feet and ankles in a detrimental way. ❌

Treatment may involve:

Massage of the muscles in the lower leg and pelvic region.
Dry needling to promote blood flow to the area and disengage trigger points.

Joint mobilisation & manipulations of the ankle and foot to improve joint function and active range of motion.
Application of deep friction techniques on the Achilles tendon.
It is recommended to limit or avoid activities, such as running, that may worsen the condition.
Your osteopath may suggest consulting with a GP or pharmacist for the prescription of nonsteroidal anti-inflammatory drugs (NSAIDS) to aid in the reduction of inflammation if tendonitis.

The use of anti-inflammatories 💊 & ice 🧊 for tendon problems is being questioned. Overusing these treatments may prevent normal healing processes in cases of true inflammation. Inflammation is needed to clean up cellular debris in the injured area, delaying or incomplete healing can result in chronic problems of tendinosis and/or tendiopathy.

In severe cases, immobilisation of the foot through casting or booting may be necessary to restrict ankle movement, decrease pressure on the Achilles tendon, and facilitate healing.
Additional examinations may be necessary, including a foot x-ray, ultrasound, and potentially blood tests to assess levels of inflammation. An MRI scan of the tendon may also be recommended.
As your symptoms improve whether it be tendonitis, a tendinopathy or bursitis, strengthening and stretching exercises will be implemented. To assist in restoring the muscles and soft-tissue structures back to their “normal” state and improving stability to avoid reoccurrence of the injury in the future.

The treatment and management approach will be selected on the basis of how long the injury has been present and the degree of damage to the tendon. It is imperative that you look after your feet and ankles. They keep you moving and give you the ability to roam day to day, it is wise to look after them accordingly, especially when they are in pain.

Exercise Rehabilitation

What your program could look like

Phase 1: Weeks 1-2

Patient status: Pain and difficulty with all activities, difficulty performing ten 1‐legged heel raises
Goal: Start to exercise, gain an understanding of your injury and the pain‐monitoring model
Treatment program: Perform exercises every day

Pain‐monitoring model information and advice on exercise activity
Circulation exercises (moving foot up/down)
Two‐legged heel raises standing on the floor (3 sets of 10‐15 repetitions/set)
One‐legged heel raises standing on the floor (3 sets of 10)
Sitting heel raises (3 sets of 10)
Eccentric heel raises standing on the floor (3 sets of 10)

Phase 2: Weeks 2-5

Patient status: Pain with exercise, morning stiffness, pain when performing heel raises
Goal: Start strengthening
Treatment program: Perform exercises every day

Two‐legged heel raises standing on edge of stair (3 sets of 15)
One‐legged heel raises standing on edge of stair (3 sets of 15)
Sitting heel raises (3 sets of 15)
Eccentric heel raises standing on edge of stair (3 sets of 15)
Quick‐rebounding heel raises (3 sets of 20)

Phase 3: Weeks 3–12 (longer if needed)

Patient status: Handled the phase 2 exercise program, no pain distally in tendon insertion, possibly decreased or increased morning stiffness.
Goal: Heavier strength training, increase or start running and/or jumping activity
Treatment program: Perform exercises every day and with heavier load 2‐3 times/week

One‐legged heel raises standing on edge of stair with added weight (3 sets of 15)
Sitting heel raises (3 sets of 15)
Eccentric heel raises standing on edge of stair with added weight (3 sets of 15)
Quick‐rebounding heel raises (3 sets of 20)
Plyometric training