Achilles Tendonitis

Greek mythology, mainly via Homer’s Iliad, tells us about the warrior hero Achilles and his invulnerability, excepting for one weak spot – his heel.  Today, whilst the Achilles tendon is the largest tendon in the human body, connecting the calf muscles to the heel bone and is immensely strong being able to withstand forces of up to 1,000 pounds, it is also the most frequently ruptured tendon in the body, especially among middle aged men. 

With each tendon enduring up to 3 – 12 times your body weight when walking or running, it is no wonder that professional athletes and weekend “warriors” can suffer from Achilles tendonitis, a common overuse injury which in its simplest form is an inflammation of the tendon.  It is estimated that around 10 – 15% of all running injuries are due to Achilles tendonitis and unfortunately, because of a poor blood supply, it is an injury that is very slow to heal.  Furthermore, if it is not treated effectively and it is continually overused whilst inflamed, this can lead to small tears within the tendon which may eventually rupture.

Estelle Mitchell, Chartered Physiotherapist, Biomechanical Specialist and Musculoskeletal Specialist advises that “As people age, tendons become less flexible, more rigid and more susceptible to injury which is why the middle-aged recreational athlete is most vulnerable.   Overpronation, which is the rolling in of the foot as you walk or run and is common if you are slightly flat-footed, is the most common reason for Achilles tendon problems and of course with overpronation being a biomechanical issue affecting how you walk, it needs a biomechanical solution.

“The other common cause of Achilles tendonitis is inflexibility of the tendon and women who wear high-heeled shoes often, and then switch to trainers for exercise, can be very vulnerable. This is because both the Achilles tendon and lower leg muscles adapt to the shortened position that high heels give and when flat shoes or trainers are worn, this forces the Achilles tendon to stretch further than it is used to, causing inflammation and pain.  If high heels are worn everyday, stretching should be done every morning and night to keep the Achilles tendon lengthened.”

In most cases, symptoms of Achilles tendonitis develop gradually, pain being mild at first and worse with continued activity.  The pain will be worse where the tendon inserts on the heel bone and sufferers usually experience the most pain while participating in activities, such as running or jumping or conversely, after periods of inactivity, most often after first walking in the morning and when getting up after sitting for long periods of time.

An Achilles tendon rupture is a partial or complete tear of the Achilles which generally comes on suddenly, sometimes with a popping sound and can be seriously painful.  Achilles tendon ruptures are most likely to occur in the middle aged athlete who has not been training or who has been doing relatively little training.  Treatment for an Achilles rupture includes complete immobilization for a long period of time or surgery.

Estelle advises that “The best treatment for Achilles tendonitis is prevention! 

• Stretch the Achilles tendon before exercise and even at the start of the day to maintain flexibility.
• Warm up properly before exercise.
• If you are an athlete, choose your trainers carefully making sure they provide sufficient cushion for the heel strike but just as importantly, not too much.
• Increase both your running distance and speed gradually and again, be careful that hill work is also introduced gradually.
• Use computerised prescription orthotics to correct over-pronation when you walk or run.
• Cool down properly after exercise.

“If you do damage the tendon and it is minor, it may respond to a simple course of treatment known as RICE (rest, ice, compression, elevation). Patients are advised to:

• Rest the tendon by keeping off their feet as much as possible
• Ice the area (a bag of frozen peas being excellent but wrap it in a damp tea-towel first) for 10 minutes at a time every hour for a day or two to reduce swelling
• Compress the ankle and foot with a firmly (not tightly) wrapped elastic bandage
• Elevate the foot whenever possible to minimize swelling.

“An anti-inflammatory may also be used to reduce pain, swelling and inflammation.”

Problems with foot mechanics can be treated with orthotics.  Estelle states that “If we can correct the imbalances in how people walk, in this case over-pronation, then we can help get rid of most of their problems and give them a long term solution to their pain rather than just papering over the cracks!  Orthotics may well be the solution for many people to avoid unnecessary pain at best, and surgery and incapacitation at worst.  What you should never do is have the tendon injected with a steroid.  Most modern specialists agree and studies have shown that this can hugely increase the risk of a total rupture!”

What is hugely exciting to treat an Achilles tendon injury and indeed any cartilage, tendon or ligament problem is a new derivative of Magnetic Resonance Imaging (MRI) Scanner technology.  Using similar principals to MRI Scanners, German scientists, researchers and medical specialists have developed Magnetic Resonance Therapy (MRT) offering what was previously thought of as impossible, a drug free and surgical free alternative to help the body re-grow of cartilage.

A number of scientific, double blind, placebo controlled and randomised tests, documented research and clinical trials on over 13,000 patients have shown that this technology can naturally stimulate the chondrocyte cells aiding in the re-growth of cartilage, the repair and healing of tendons and ligaments and indeed, bone related osteoporosis problems.

Remember, pain of any sort is not a necessity! 

To discuss tendonitis, orthotics or indeed any other problem you may have, patients may self refer direct to Estelle Mitchell, Biomechanical and Musculoskeletal Specialist and your English Chartered Physiotherapist by calling 952 883 151 or by visiting her websites at: www.thebodyworksclinic.com, www.marbellaphysio.com or www.physiofoot.com