What is Achilles tendinopathy?

The Achilles tendon is the strongest and thickest tendon in the body.  The tendon’s responsibility is to transmit force from the calf muscles of the lower leg to the heel bone of the foot to create motion, mainly pointing the foot downward like when stepping on the acceleration pedal in a car or standing on the tips of the toes; this motion is natural when walking and running.  Achilles tendinopathy is a combination of symptoms which include pain and possible swelling in the area of the Achilles tendon and a decrease in the ability to perform activities.  The area mainly affected is the mid portion of the tendon roughly 2-6 cm up from where it attaches on the heel bone.  This is due to a naturally occurring decreased amount of blood flow to that portion of the tendon.

How does it happen?

There are many risk factors for Achilles Tendinopathy.  Some of these risk factors include, but are not limited to:

  • Excessive mileage with running.
  • A sudden increase in the intensity of activity (as seen with training programs for races or events)
  • A decrease in the amount of recovery time between workouts
  • Improper foot wear when performing activity
  • Age (>35)
  • A sudden increase in body weight and/or height (as seen in adolescent growth spurts)
  • Muscle weakness in muscles of the ankle, knee, and hip
  • Muscle imbalances
  • Excessive muscle tightness
  • Excessive arch in the foot (called pes cavus)
  • Instability in the outer portion of the ankle
  • Trauma such as a strong muscle contraction when running or the large amount of force that occurs when landing from a jump.

Signs and Symptoms

The main signs and symptoms again include pain with potential swelling in a portion of the Achilles tendon, mainly 2-6 cm above the attachment of the tendon to the heel bone.  With swelling it can be named Achilles Tendonitis.  Initial injury can present with a gradual onset of pain during the beginning or end of an activity with a brief period of no pain or relief of pain midway through the activity.  This can progress to constant pain throughout the entire activity due to stress and overuse.  The onset of pain in the morning is a sign of disease progression.  It is also good to know that pain can be caused by the recovery process as well.  When the tendon is damaged the body begins to form new nerves and blood vessels to replace the ones that were damaged.  The formation of these new nerves can cause sensations of pain but can be decreased with treatment.  It is important to note that if Achilles tendon issues are not taken care of, a complete rupture can occur which is an extremely more devastating of injury.

For more information on physical therapy services head to www.totalperformancept.com.


If you ever feel pain in the back of the ankle that lasts more than 1-2 weeks, it is recommended to see your physical therapist.  When you see your PT, you can expect a complete evaluation/examination where they will take a brief history and test muscular strength and range of motion, among other attributes, and perform additional special tests to confirm a diagnosis of Achilles Tendinopathy.  The physical therapist will use modalities to help reduce pain and swelling if present.  An exercise program focusing on strengthening the tendon will then be implemented and supervised by your physical therapist that will be tailored to the individual to help you get back on your feet.  The use of manual therapy techniques such as deep tissue and transverse friction massage may be performed by your PT to help decrease pain and restore normal gliding motion of the tendon.  If foot arch issues are present, the physical therapist may introduce foot orthotics to help decrease pain and lessen the load on the tendon.  Progression to the gradual introduction to specific activities is added later on in the treatment course.  Patients are normally able to return to normal activities between 2-3 months of treatment.  The best thing to do if you suspect a problem with your Achilles tendon is to rest and take a break from the activities that are causing you pain/discomfort.  You should make an appointment to visit your physical therapist to get a proper diagnosis and treatment plan.  If there are activities that are causing you pain and are difficult to avoid, your physical therapist can help you modify the way you perform the activities in a way that helps keep you going but also in a way that can promote healing throughout your treatment process.

For more information on physical therapy services head to www.totalperformancept.com.


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