Achilles Tendinitis is the inflammation of the Achilles Tendon. The calf muscles (gastrocs and soleus) join together and become the Achilles Tendon, and attaches to the heel. With overuse or injury, this tendon can become inflamed and irritated, causing pain with walking, stairs, jumping, or other activities that requires the use of the calf muscles.
People with Achilles tendinitis often reports pain and swelling at the back of their ankles or heel, sometimes even referring to the bottom of the heel. There are two common types of Achilles Tendinitis: Insertional (blue square) and Non-Insertional (red square).
Insertional Achilles Tendinitis
Insertional Achilles Tendinitis is pain and inflammation at the insertion of the Achilles Tendon on the heel bone. It is often associated with swelling, redness and calcium buildup (small bump) located at the back of the heel (see picture). Pressure at the back of the heel tend to be sensitive and painful. In clinic, some of my clients often report that certain tight shoes might cause more pain in this area from the pressure and have to sometimes resort to open back shoes.
Non-Insertional Achilles Tendinitis
Non-Insertional Achilles Tendinitis is the inflammation of the middle part of the Achilles tendon. People with this type of tendinitis will often find swelling right at the back of the ankle, in the middle of the tendon (see picture, Left foot). Therefore,pressure on the swollen part of the tendon will often be very sensitive.
Causes of Achilles Tendinitis
There are multiple reasons why someone might develop Achilles Tendinitis. Here are some of the possible causes:
- People who stand or walks a lot for their job or hobby (runners, teachers, construction worker, etc.)
- Sudden increase in activity
- Suddenly increasing duration or intensity of activities involving the foot (i.e.: walking more on a trip, picking up a new sport, running after taking a long break from it, etc.)
- Stiffness of the joints in the foot
- Ankle and heel bones not moving well will cause increased in stress on the tendon during use.
- Low arches
- People with lower arches are more prone to this condition.
- Over-Pronation of the heel (see picture below, Right foot) :
- Increases stress on the tendon during use.
- Tight calf muscles & weakness of the muscles of the foot:
- Less support by the muscles of the feet and increased pulling of the calf muscles on the tendon.
Treatment Options in Physiotherapy
Although avoiding repetitive use of the foot is a good way to get rid of the pain, it often will get irritated again once you go back to doing more activities. Physiotherapy is a very effective treatment Achilles Tendinitis and a more permanent solution. We will find out the exact cause that is irritating the tendon and treat the source of the pain. Here is some treatment techniques that will be used in physiotherapy:
- Muscle Release
- Joint Mobilization of the foot
- Dry-Needling (see video about dry-needling)
- Specific and Controlled Loading Exercises
- Bracing / Orthotics (depending on the case, not always the solution)
Most people will get better with physiotherapy alone. If the tendinitis is persistent, Shockwave Therapy is another very effective back up solution.
About the Author:
Lily Zhang is a registered physiotherapist with training specializing in the McKenzie Method. She graduated from McGill University and is currently working in Barrhaven (Ottawa, ON). She has over 10 years of professional training/clinical experience in orthopedic physiotherapy. You can Follow Her Blog @PhysioVive Facebook Page.