Achilles Tendinitis / Tendinopathy

Achilles Tendon

Achilles tendon disorders are among the most commonly reported overuse injuries, with a reported annual incidence in runners between 7% and 9%. Achilles tendinopathy is more common in those participating in recreational and competitive sporting activities, however sedentary individuals can also present with the condition.

ATFTSP

Anatomy/Structure of the Achilles tendon

The Achilles tendon is the strongest and thickest tendon in the body.
The average length of the Achilles tendon is 15cm and it is the conjoint tendon of the gastrocnemius and soleus muscles (aka: triceps surae).
The Achilles tendon inserts in to the posterior process of the calcaneus (heel bone).
Investigations have identified a zone of hypovascularity (poor blood supply) approximately 2-7cm proximal to the Achilles tendon insertion at the calcaneus.

Function of the Achilles tendon

Tendons function to transmit force generate by muscle tissue to their attaching bone/s.
Tendons require a combination of mechanical strength, flexibility and elasticity.
The Soleus is the primary plantarflexor of the ankle, assisted by the Gastrocnemius.
The Gastrocnemius also functions as a flexor of the knee joint.

Pathology of the Achilles tendon

Tendinitis refers to inflammation of a tendon. Development of tendinitis is frequently associated with an acute overload of the structure. Acute overload refers to increased load on the tendon that is too heavy and/or too sudden.

Tendinopathy (Tendinosis) refers to degeneration of a tendon. Tendinopathies are characterised by poor healing responses and an absence of inflammation. Chronic overloading of a tendon is reportedly the most common pathological stimulus. There are two types of Achilles tendinopathy; mid-portion and insertional.

Excessive loading is the most common pathological stimulus that causes injury to the Achilles tendon.
Reductions in both concentric and eccentric strength of the Gastrocnemius & Soleus have been identified in those patients with Achilles tendinopathy. Additional studies have also identified decreased activity of the Gluteus Medius & Gluteus Maximus in patients suffering Achilles tendinopathy.

Causative / Contributing Factors

Overuse
Decreased vascularity
Muscle imbalance/weakness
Decreased flexibility
Decreased tensile stress associated with ageing
Foot biomechanics

Risk Factors

Diabetes
Obesity
Oral contraceptives
HRT
Hypertension

Treatments

Treatments will vary from patient to patient and will be determined by an individual biomechanical assessment.
Evidence-based treatments offered at Forster Tuncurry Sports Podiatry for the treatment of Achilles Tendinitis / Tendinopathy include;

Custom Rehabilitation Exercise Programs
(including gold-standard Stanish/Alfredson eccentric loading protocols)

Gait Rehabilitation / Re-Training

Orthotic Therapy

Laser Therapy (low level laser therapy / LLLT / photobiomodulation)

Footwear

Sports Strapping

Dry Needling

 

 

 

 

 

All information on this page is sourced from Talysha Reeve’s clinical project work undertaken┬áduring completion of Post Graduate Certificate in Clinical Rehabilitation.

 

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