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We understand that you want to fix this problem as quickly as possible. We provide the latest diagnostic and treatment options including shockwave therapy. Find out more about Shockwave therapy.
What is the Achilles Tendon?
The Achilles is the tendon that attaches the muscles of the gastrocnemius (calf) and soleus to the back of the calcaneus (heel).
Its main role is to plantarflex the ankle (pointing the foot down) and is responsible for providing most of the force at push off.
There are two main sites for Chronic Achilles Tendon Pathology:
The Midportion of the Achilles Tendon
Midportion Achilles Tendinopathy is a chronic overuse injury of the midportion of the Achilles Tendon (the midportion of the Achilles is located 2-3cm above the heel).
People with this problem generally present with pain when first getting out of bed which reduces slightly after walking a short distance and then returns again with extended walking.
It is also a common feature that there may be a nodule in the middle of the Achilles tendon- this occurs when there is a fat build up within the tendon and will present as a palpable nodule.
The Insertion of the Achilles Tendon
Insertional Achilles Tendinopathy is a chronic overuse injury at the insertion of the Achilles Tendon.
People with this problem generally present with pain when first getting out of bed which reduces slightly after walking a short distance and then returns again with extended walking.
Causes of Achilles Tendinopathy
Mid portion Achilles Tendinopathy
Involves chronic degeneration at the mid portion of the Achilles tendon.
Insertional Achilles Tendinopathy
Involves chronic degeneration at the insertion of the Achilles.
Risk Factors for Achilles Tendon Pain
Bony Irritation (Insertional Achilles Only)
It is also a common feature to have a prominent bone at the back of the heel with this particular problem either a Haglunds deformity or a retrocalcaneal exostosis. Haglunds deformity is a bony prominence that is higher up on the calcaneous when compared to a retrocalcaneal exostosis which typically has an intratendenous component.
Certain medications (Fluoroquinolones – ciprofloxacin)
Non- Supportive footwear
Flat arched feet
High arched feet
Sudden increase in activity
Trauma
Being overweight
Hormone problems (Reduced Thyroid function, Menopause)
Connective tissue disorders (Rheumatoid arthritis)
Diagnosis of Achilles Tendinopathy
Diagnosis is generally made with specific signs and symptoms – when the pain occurs and the location.
At the Ankle, Foot and Orthotic Centre we are able to provide additional information about the presence of Midportion Achilles Tendinopathy or Insertional Achilles Tendinopathy with ultrasound imaging.
Typically, someone with Midportion Achilles will have a thicker disorganised midportion area in the midportion of the Achilles. This is in addition to extra blood vessels in the tendon.
Typically, someone with Insertional Achilles will have disorganisation at the insertion of the Achilles.
Treatment of Achilles Tendon Pain
Treatment aims to reduce the disorganisation of the connective tissue in the Achilles tendon and also minimise the risk factors for re-injury. This can include:
Shockwave therapy
Tendon Fenestration (Midportion Achilles)
Orthotic correction
Stretching Alfredson Eccentric Stretches
Taping
Home Massage techniques
Night Splinting
Surgery to remove an osseous components and repair the tendon (insertional achilles)
What else could it be? (differential diagnosis)
- Retrocalcaneal bursitis
- Kagers Fat Pad Inflammation
- Tarsal Tunnel Syndrome
- Tibialis posterior tendon dysfunction
Book Your Podiatry Appointment Online
The Ankle, Foot and Orthotic Centre’s Northcote Podiatrists can help you with all lower limb complaints, including Achilles Tendon pain. Make an appointment to get your foot and ankle pain under control.
Your Local Podiatrists and Orthotists in the treatment of Achilles problems servicing the areas of Northcote, Thornbury, Fitzroy, North Fitzroy, Carlton, North Carlton, Alphington, Fairfield, Brunswick, Coburg and Preston.
Call The Ankle, Foot and Orthotic Centre in Northcote for further advice on professional management and treatment options.