The Achilles tendon
The Achilles tendon is the thickest in the human body and is located at the back of the lower leg, close to the heel bone. It can withstand approximately four times a person’s body weight when walking, and its thinnest point is 4 cm wide.
The tendon begins in the middle of the calf, extends approximately 15 centimetres down to the heel, and passes behind the ankle in a vertical direction.
What is Achilles tendinopathy?
This term describes the clinical presentation of Achilles tendon pain associated with activity. It is a common ailment among athletes that is frequently brought on by overtraining.
It may affect 9% of recreational runners and cause up to 5% of professional athletes to end their careers.
Achilles tendonitis or tendinopathy is a painful condition which can affect different parts of the Achilles tendon. The term ‘tendonitis’ is used when the issue is more acute and there is inflammation of the tendon whereas ‘tendinopathy’ or ‘tendinosis’ refers to more chronic, degenerative changes within the tendon structure.
In addition, you can have ‘insertional’ Achilles pain, which is felt right at the back of the heel where the tendon inserts into the bone or ‘mid portion’ pain which affects the area higher up the tendon (midway between the heel and where the tendon and muscle join).
Why is it important to maintain the integrity of the Achilles tendon?
The Achilles tendon attaches the calf and Soleus muscles to the heel bone. These muscles cause your foot to move downwards at the ankle via the tendon. It aids your foot in stair climbing, jumping, running, walking, and standing on your toes.
You may wonder, given that the tendon is so resilient, how it can become damaged.
If you overuse or overwork a tendon beyond its load capacity, it may be susceptible to a variety of conditions and disorders.
Damage to the Achilles tendon may lead to conditions such as bursitis, tendonitis, tendinosis and tendon rupture.
Repetitive high load activities, like running, walking or sports causes your Achilles tendon to swell and become painful.
Weakness in the calf muscles will impede the foot’s downward mechanism and cause the Achilles tendon to become strained.
Changing your footwear, for instance from high heels to flats, will affect the tensile integrity of the tendon and may cause Achilles tendon bursitis by inflaming the bursa at the back of your heel. Bursitis can also be caused by heel injuries or diseases like rheumatoid arthritis or gout.
Your tendon gradually degenerates as a result of overuse or ageing, resulting in the formation of scar tissue. This then develops into Achilles tendonitis.
How can you tell if your Achilles tendon has been injured?
You may experience pain when stretching the ankle or standing on your toes if you have tendinitis; the pain may be mild at first and gradually intensify. If the tendon has ruptured, the pain can be severe and sudden. In this situation, flexing the foot or pointing the toes may be difficult.
You may also experience tenderness around the Achilles region. During an injury, there may be swelling, the tendon may become stiff, and you may hear a snapping or popping sound.
How are Achilles (calcaneal) tendon problems treated?
Calcaneal tendon problems are usually treated with non-surgical treatments though in some cases, severe Achilles tendonitis can lead to an Achilles tendon rupture which requires surgery.
The treatments for insertional and mid portion tendon issues are different. Furthermore, there are differences in treatment interventions for tendinitis and tendinopathies. This means it’s important that you get a proper diagnosis to ensure you receive appropriate treatment.
Depending on what your podiatrist finds during their assessment and the subsequent diagnosis, treatment options can include insoles, heel lifts in your shoes, exercises and activity modification. In our clinic, we have an MLSⓇ laser and Extra Corporeal Shockwave Therapy (ESWT) which can be a very helpful addition to your treatment plan.
MLS laser helps to reduce pain, swelling and inflammation as well as accelerating your body’s own natural healing process. The MLS laser delivers two wavelengths, 808nm and 905nm in a synchronised manner. Because the stronger 905nm wavelength is Nano pulsed (this means it pulses on and off rapidly), any risk of thermal damage to your tissue is removed and the laser is completely safe to use. The 808nm wavelength targets tissue repair and regeneration and the 905nm wavelength has an analgesic effect and targets pain and inflammation.
Shockwave therapy, on the other hand, uses mechanical pressure waves, not electric and are generated outside of the body. It is a very low-risk procedure. The shockwave is produced from the impact of a small ballistic projectile impacting against an applicator head via a powerful air compressor. This acceleration/ deceleration transmits kinetic energy which propagates radially as a wave into the tissues via a coupling gel.
Shockwave is an evidence-based technology that accelerates the body’s natural healing process by passing low energy waves into damaged tissues. These waves stimulate metabolism, increase blood flow and stimulate repair whilst reducing pain allowing your body to restart its own natural healing process.