What is Achilles Tendinopathy?
The Achilles tendon is an important musculoskeletal tissue that runs from the gastrocnemius muscle in the calf to the posterior calcaneus. This allows the movements of plantar flexion (“tippy-toeing”) and dorsiflexion, which are used in most activities (anything that involves running). Achilles Tendinopathy (AT) is an overuse injury that occurs in both active and inactive people. Studies have shown that the pain as a result of AT is not inflammatory in nature, but rather is the result of the lack of healing response to overuse in the tendon which results in pain.
What are the signs and symptoms?
After an effort a patient might experience heel pain, tenderness, heel stiffness and swelling in the back of the ankle. Pain is typically worse when on your toes or in active plantar flexion like doing calf raises.
How is it diagnosed?
Along with the signs and symptoms listed above, there are special tests during the physical exam which can reveal that a patient has the diagnosis of AT. The first test, which should take place in the exam room is the “Thompson Squeeze Test” which can reveal an acute injury or Achilles tear. After an acute injury has been ruled out the next step would be to simply load the tendon to unmask a pathology. This can be done with a single-leg heel raise or hopping in one spot. Imaging can also be used in addition to a good exam i.e., ultrasound or MRI to help verify the diagnosis.
How to treat it?
The majority of AT can be treated with nonsurgical therapy. With the onset of mid-tendon pain the first step is to identify if there is a complete rupture. Once that is ruled out, a patient can begin with heel-strengthening exercises. Eccentric loading exercises should be the mainstay of a home exercise program as there is abundant evidence supporting this mode of exercise for AT rehab. If they do no respond, there is a stepwise progression of treatments involving medical management (NSAIDs and Corticosteroid injections) and formal physical therapy. If all other noninvasive measure fail, surgery may be a last resort.
AT is prevalent in patients who very active but without adequate rest periods. It is also found in those who are “weekend warriors” meaning they are sedentary during the week but then overexert themselves on an occasional exercise bout. Therefore, it is important in both types of patients that there is adequate rest between exercise, along with slow increasing progression of intensity and/or duration of activity. It is also important to adequately strengthen and stretch the targeted muscles affected by AT. Including standing calf raises in a workout regimen especially with an emphasis on the eccentric movements are simple and effective in prevention of AT. After someone completes an intense bout of exercise it is also essential that they perform stretches on the calf muscle for 10-30 second holds.
By Tommy Yang and Mo Mortazavi, MD