Achilles tendon pain is a common complaint, particularly among those who do a lot of running, or for those of us in middle age and beyond. The Achilles tendon is the thick band of tissue which runs from the back of the calf and attaches into the heel bone.

The tendon is formed from the two calf muscles which allow us to raise onto our toes, the gastrocnemius muscle and the deeper soleus muscle.

Everybody is probably familiar with somebody who has ruptured the Achilles tendon. These injuries often occur with no warning sign; people describe a feeling of being hit or kicked in the back of the leg and are usually unable to walk. These injuries require early medical assessment and are managed with either surgery or by plaster for a period of weeks.

Far more common and less serious are the conditions of Achilles tendinosis and Achilles tendonitis. Achilles tendonitis (-itis meaning inflammation) occurs as a result of an acute injury to the tendon. The tendon becomes painful, hot and swollen. Pain is worse with walking and stretching. This condition usually improves quite quickly and responds to treatment by rest, ice and graduated stretching and strengthening before a return to activity.

Achilles tendinosis describes the condition whereby there is degenerative change within the tendon. This is the most commonly occurring Achilles tendon problem.

Patients describe a gradual onset of pain which might arise as a consequence of starting some exercise such as walking or running, or because of an increase in training. The pain is often not severe initially and people delay seeking help because they believe it will just go away given time. The pain slowly worsens and is present on getting out of bed in the morning, on standing after sitting, and when walking or running. Tendinosis occurs when microtrauma to the tendon fibres happens at a greater rate than the body is able to repair the damaged tissue. The rate of repair slows as we get older, and therefore the problem is more prevalent in middle age and beyond. In order to regenerate the damaged tissue the tendon needs some signals to trigger formation of new healthy tissue. This trigger is often in the form of specific strengthening exercise, and there is now a strong body of research supporting management of this often difficult problem with strengthening regimes.

There are often a number of co-existing factors which may predispose to Achilles problems. These include poor flexibility of the calf muscles, faulty foot mechanics such as excessive pronation, poor hip and trunk stability, weak calf muscles and faults in training and footwear. In order to mange this problem effectively all of these factors should be assessed and managed appropriately. A detailed assessment by a qualified sports physiotherapist will identify contributing factors and establish the correct treatment programme. The Achilles problem need not be your Achilles heel!

Mike Stewart is a Physiotherapist at the Oamaru Physiotherapy Clinic. He has post graduate qualifications in Manipulative Physiotherapy and Sports Medicine and is a Registered Physiotherapy Acupuncturist. He has toured as a Physiotherapist with the Maori All Blacks for the last 14 years.

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