Achilles Tendon Pain

What is the function of the Achilles Tendon?

The Achilles tendon (or heel cord) is the thick tendon that runs down the back of the ankle joint. The tendon is made up of many bundles or fibres of a strong material called collagen. It is the tendon of the large muscles that make up the calf. When the muscle contracts, the Achilles tendon pulls on the heel to make us go up on tiptoe, or pushes us forwards when walking or running.

What causes Achilles Tendon pain?

Most Achilles tendon problems are basically overuse injuries. Therefore it is more common in middle aged athletes. As we get older the tendon becomes less flexible and less able to absorb the repeated stresses of running. Eventually small tears occur in the fibres of the tendon. The body tries to repair these tears, however, sometimes the wear rate exceeds the repair rate. Instead, the tendon and its lining become painful and swollen, and the tendon may feel weak. The combination of degenerative and repair processes in the tendon is called tendonosis or tendonitis. In the severe cases, the tendon becomes weakened by the degenerative process to the extent that it can rupture completely.

How would I know if I had an Achilles tendon problem?

If you had a complete tear, you feel a sudden pain in the backside of the ankle or calf. Some people say this feels as though they had been kicked in the calf. Usually the ankle becomes painful, swollen and bruised, and it becomes difficult to walk.

Achilles Tendonitis develops more gradually. The Achilles tendon becomes painful and a swelling may develop in or around the tendon. At first the pain is present mainly on running or playing sport, but later it may be difficult to walk because of the painful tendon.

What can I do to help?

Achilles tendonitis can be treated like any overuse problem in the first instance by reducing the distance or the frequency of the sports. Adequate warming up and plenty of Achilles stretches always help. Running on a softer surface and a good running shoes also help. A slight heel raise on your shoe will reduce the stresses on the tendon. For the pain, try simple pain-killers such as paracetamol. Anti-inflammatory ca be useful but check with your doctor as they can have side-effects in some people.

When should I get professional advice?

If you think the tendon has torn completely, you should go to your local A&E department. If a painful tendon does not improve with the treatment recommended above, you should consider consulting your GP.

What are the investigations needed?

If there is a possibility that the tendon is torn, a scan of the tendon may be arranged. Often an ultrasound scan will give enough information, but a magnetic (MRI) scan is more useful in some cases. An X-ray of your heel is sometimes useful to check the tendon insertion.

What can be done?

Physiotherapy is the mainstay of treatment of Achilles Tendonitis. The programme is aimed at reducing the inflammation first. Once the inflammation is improved, the physiotherapist will start exercises to strengthen and stretch the Achilles tendon. If your foot is flat or high arched, a moulded insole in your shoe may help. Most people will improve with physiotherapy. A few continue to have trouble and in this case surgery may be considered.

Will I need an operation?

The surgeon would probably want you to have a scan before any surgery, to show whether there is a problem in the tendon which can be corrected by surgery.

If there is tenosynovitis but the tendon itself is reasonably healthy, stripping out the inflamed tendon lining often gives good results. If the problem is tendonitis, surgery would involve removing the degenerate tendon and repairing the remaining tendon. This can be done by open, minimally invasive or endoscopic techniques.

Will I have to give up running?

Usually not. You may need to reduce your distance for a while to allow your tendon to heal. Some people who have surgery will not get enough tendon strength or flexibility to allow them to return to running or sport.