Achilles tendinopathy
Achilles tendinopathy is extremely common and occurs at two points along the Achilles tendon which connects the large calf muscle (gastrocnemius and soleus) to the heel bone. The tendon's job is to flex the ankle and allow you to stand on tip-toes.
Non-insertional Tendinopathy
Most commonly, the Achilles tendon gives problems just above the heel bone. This is where it has a poor blood supply. For some patients the Achilles “grumbles”. Thickening and tenderness of the tendon is associated with pain and stiffness, characteristically noticed when first rising in the morning.
Patients say they hobble like an old man/woman for the first few minutes of walking. There are a vast number of treatments for this problem, but for 90 per cent of patients enough stretching, undertaken with the guidance of a specialist foot and ankle physiotherapist using the correct techniques, will greatly improve the symptoms and help the tendon to heal.
For stubborn cases, modern injection techniques (not cortisone, which can further damage the tendon) are widely used and can provide relief for some patients, but their overall effectiveness has not been proven. Surgery is rarely required, but for very difficult cases, it can be very effective.
Acute rupture
For other patients, who have usually had no previous trouble with the tendon, sudden rupture occurs. Classically this is on the squash court and the sudden pain is associated with an audible snap. Patients often say that they thought they were struck by the ball (or their opponent’s racquet).
Swelling and bruising results, and sometimes an Achilles tendon rupture is mistaken for a sprained ankle by inexperienced clinicians. Surgery to repair the tendon restores it to the correct tension and has a low risk of re-rupture.
In selected cases, it is possible to achieve a good result for Achilles tendinopathy without repair. In all instances appropriate rehabilitation, in a plaster or protective boot, allows walking upon the leg at an early stage is essential. Physiotherapy out of plaster/boot begins after six weeks.
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