Achilles Tendinitis/Tendinosis

What is it?

The Achilles tendon connects the three muscles of the calf (two gastrocnemius and the soleus muscles) to the heel of the foot (calcaneus). It is one of the longest and strongest tendons in the body, required for walking and standing. Since tendons have poor blood supply they are slow to heal and may become infiltrated with fibroblasts, cells that lay down scar tissue. In small amounts, scar tissue is helpful during an acute (new) injury. If the inflammation and scar tissue becomes chronic, the tendon becomes less elastic and thickened. This is called Achilles Tendinosis.

What are the symptoms?

The most common symptoms are aching, shooting or burning pain in the back of the heel. It is painful to go upstairs or rise up onto the toes.

What causes it?

An Achilles injury may be sudden or a repetitive injury. Some common causes of sudden injury occurs when a shortened tendon, from wearing high heels, previous injuries and scar tissues, or a lack of stretching, is pulled during a sudden burst of movement like jumping or running.

Repetitive Achilles tendon injury is usually related to faulty foot biomechanics involving over-pronation (arch dropping) that starts at the heel. As the heel bone (calcaneus) drops inward with every step, it tugs on the tendon, pulling and causing inflammation. The tendon is stressed a second time as the foot pushes off and the calf muscles contact to point the toes. This means that the Achilles tendon never gets a rest and, therefore, the inflammation can easily become chronic.

How is it treated?

The first objective of treatment is to control the pain and inflammation. This is usually achieved through ice therapy and modalities such as ultrasound or laser therapy. At this point, low, bilateral (right and left) heel lifts are helpful to reduce stress on the tendon.

Once the pain and inflammation have been reduced, you can gently begin stretching, holding each stretch for 30-60 seconds. While this is helpful, it doesn’t address the cause of the problem if over-pronation is involved. A custom orthotic will address the specific biomechanical needs of each foot (the right and left foot usually have different needs). While complete recovery from chronic Achilles Tendinosis may take a number of months, the corrective custom orthotic will prevent the problem from getting worse and allow you to return to activities that you could not do previously.