Achilles Tendonitis

The Achilles tendon is the largest tendon in the body and can withstand heavy loads of tension for long periods. The problem is this structure is avascular (poor blood supply) which explains why this condition is slow to heal. There are several causative factors include poor footwear, change of surface, ballistic jumping and bounding, poor calf and soleus flexibility to name just a few. Irritation to the Achilles tendon is the most common injury in the lower ankle region. This is secondary to muscle shortening of the calf, soleus, plantaris and the plantar flexor structures. These muscles directly and indirectly attach and affect the Achilles tendon causing mechanical overload as it connects down onto the heel bone. Another structure that flares up in conjunction with AT is the retro-calcaneal bursa, this is located at the base of the Achilles tendon attachment.

The individual usually notices a gradual development of symptoms and typically will complain of pain and stiffness immediately on rising in the morning. This pain then eases with walking or during training, only to recur several hours afterwards.

On examination pain and tenderness is usually felt with digital pressure applied to the calf structures and extreme tenderness is felt upon squeezing the Achilles tendon especially at its attachment point to the heel bone.

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Treatment

Treatment initially requires a reduction of the pain and inflammation using ice, ultrasound and electrotherapy. A heel raise is sometimes administered to reduce excessive loading on the tendon. This is then followed with transverse and longitudal frictions over the paratendon as well as myofascial release to tight calf, soleus, plantaris, and the sole of the foot. IMS (acupuncture) is also employed to release tight muscle bands situated all throughout the posterior compartment of the lower leg.

The next step is to restore full extensibility to the tendon. This achieved through an active stretching programme in standing and kneeling. Finally, after once the pain in the tendon has dampened, a strength programme is introduced. This consists of eccentric loading, which promotes collagen formation along the tendon, thereby increasing the elastic and tensile properties of the tendon. A functional strength programme is then provided. At KCphysio we pledge that within 4-5 treatments Achilles tendonitis will show significant improvement and or will be fully resolved.

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