What is the function of the Achilles Tendon (AT)?

The achilles tendon is a fibrous band of tissue that links the muscles in your calf to your heel. Jumping, running and walking all rely on the strength and flexibility of this tendon.

The achilles tendon attaches the posterior calf muscles – gastrocnemius and soleus, to the calcaneus. Its action is to plantarflex the ankle and resist ankle dorsiflexion. Inappropriate management of achilles tendinopathy can result in unfavourable outcomes, such as impaired quality of life.

 

What is Achilles Tendinopathy?

Achilles tendinopathy refers to a combination of various intrinsic and extrinsic factors affecting the achilles tendon commonly due to overuse and excessive loading upon the tendon. This may or may not be associated with an achilles tendon tear. A lack of flexibility or a stiff achilles tendon can increase the risk of these injuries.

Achilles tendinopathy can present either at the mid-portion of the achilles tendon (AT) or at the Insertion of the (AT).

 

Who is most susceptible to developing AT?

This can affect both athletes and non-athletes. However, the disorder is most frequently seen in runners and running sports in the age range from 30 to 60 years old.

 

What are some of the risk factors that contribute to (AT)?

  • Intrinsic risk factors include increasing age, male sex, lower limb malalignment, limb length discrepancy, limited ankle dorsiflexion, obesity, chronic diseases that affect the tendon quality such as diabetes, rheumatoid arthritis, hypercholesterolemia.
  • Extrinsic risk factors include use of fluoroquinolones and corticosteroids, which have been found to cause weakening of the tendon, increasing risk of tendon rupture. Training errors and fatigue can contribute to the development of this condition.

 

What are the common symptoms?

  • Gradual onset of pain
  • Stiffness and pain can present at the back of your heel especially during the first steps when getting up of bed in the morning or after a period of inactivity
  • Then usually seems to improve with mild activity or when the tendon has warmed up
  • The tendon at the back of the ankle may be warm and tender to touch
  • The tendon can be inflamed and can look thicker in appearance

 

Conservative management plan

  • Review and decrease your activity levels (load management)
  • Wear appropriate footwear
  • Perform your stretching and strengthening calf exercises as indicated by your health practitioner
  • Possible prescription of orthotics to aim to align the calcaneus into a more vertical position, thus, reducing bending forces on the tendon, such as in a pronated foot
  • Icing on the area for pain and inflammation management

Note: Please remember that wearing appropriate footwear and maintaining an optimal loading are key factors to prevent AT injury.

For more tips and further advice, visit one of our CSSM podiatrists.

 

About the Author

CSSM Podiatrist Paula’s sporting background has provided her with a particular interest in the recovery and management of foot and ankle injuries.

“Our feet are what keep us moving every day, they are the wheels in our daily journey, and they work very hard all year around. Therefore, prevention and proper management of foot problems are essential for our mobility, comfort and health.”

While Paula believes Podiatry enables her to choose her own pathway from rehabilitation of the foot and ankle, biomechanics, running gait analysis to skin conditions, she hopes to specialise in the rehabilitation of injuries and sports Podiatry.

 

References

Alfredson, H., Pietila, T., Jonsson, P., & Lorentzon, R. (1998). Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. The American Journal of Sports Medicine, 26(3), 360-366. doi:10.1177/03635465980260030301

Ankle and foot centre (2019). Diagnosis of Midportion Achilles Tendinopathy. [Image]. Retrieved from: https://ankleandfootcentre.com.au/midportion-achilles- tendinopathy/

Asplund, C. A., & Best, T. M. (2013). Achilles tendon disorders. The BMJ, 346, 29-33. doi:10.1136/bmj.f1262

Benjamin, M., Theobald, P., Suzuki, D., & Toumi, H. (2007). The anatomy of the Achilles tendon. The Achilles Tendon, 3, 5-16. Retrieved from http://eknygos.lsmuni.lt/springer/503/5-16.pdf

Brockett, C. L., & Chapman, G. J. (2016). Biomechanics of the ankle. Orthopaedics and trauma, 30(3), 232–238. doi:10.1016/j.mporth.2016.04.015