Achilles tendonitis is often now being referred to as achilles tendinopathy. This is because it is no longer thought to be an inflammatory condition. On investigation, the main finding is usually degenerated tissue with a loss of normal fibre structure.
Achilles tendonitis can be either acute, meaning occurring over a period of a few days, following an increase in training, or chronic which occurs over a longer period of time. In addition to being either chronic or acute, the condition can also be either at the attachment point to the heel or in the mid-portion of the tendon (typically around 4cm above the heel). Healing of the achilles tendon is often slow, due to its poor blood supply.
Symptoms of Achilles Tendonitis
Gradual onset of pain over a period of days
Pain at the onset of exercise which fades as the exercise progresses.
Pain eases with rest.
Tenderness on palpation.
Chronic achilles tendonitis may follow on from acute tendonitis if it goes untreated or is not allow sufficient rest. Chronic achilles tendonitis is a difficult condition to treat, particularly in older athletes who appear to suffer more often.
Gradual onset of pain over a period of weeks, or even months.
Pain with all exercise, which is constant throughout.
Pain in the tendon when walking especially up hill or up stairs.
Pain and stiffness in the Achilles tendon especially in the morning or after rest.
There may be nodules or lumps in the achilles tendon, particularly 2-4cm above the heel.
Tenderness on palpation.
Swelling or thickening over the Achilles tendon.
There may be redness over the skin.
You can sometimes feel a creaking when you press your fingers into the tendon and move the ankle.
Causes of Achilles Tendonitis
Achilles tendonitis is an overuse injury. Too much too soon is the basic cause of overuse injuries, however other factors can contribute to developing the condition.
Increase in activity (either distance, speed or hills).
Less recovery time between activities.
Change of footwear or training surface.
Weak calf muscles.
Decreased range of motion at the ankle joint, usually cause by tight calf muscles.
Running up hills – the achilles tendon has to stretch more than normal on every stride. This is fine for a while but will mean the tendon will fatigue sooner than normal.
Overpronation or feet which roll in when running can place an increased strain on the achilles tendon. As the foot rolls in (flattens) the lower leg also rotates inwards which places twisting stresses on the tendon.
Wearing high heels constantly shortens the tendon and calf muscles. When exercising in flat running shoes, the tendon is stretched beyond its normal range which places an ‘abnormal’ strain on the tendon.