‘What causes Achilles Pain & is really Achilles Tendonopathy?’
Achilles Tendonopathy is characterised by pain on walking or running into the achilles tendon, which attaches to the heel bone. It is an overload condition, meaning that the tensile strength of the tendon becomes overloaded due its strength being less than what is required for the training program of an individual or athlete.
Overload Causes of Achilles Tendonosis Pain
A sudden increase in Loading capacity on the tendon due to an increase in running distance or an increase in the intensity of training.
Sudden increase in Plyometric skills training, or speed training
Can occur when returning to high intensity training after a week’s rest – the tendon’s load capacity is reduced in the rest period and is suddenly overloaded on return to training resulting in injury.
Changes in Footwear such as wearing a Lower Heal running shoe
Change in training surface - Training on a softer surface produces less energy return to the tendon.
Being Overweight – fatty waste build-up within the Achilles tendon leading to reduced load capacity
Post-Menopausal Woman – load capacity of the tendon is reduced
Poor running technique – striking the ground heavily with heal
Poor alignment in running technique when the heal strike is further ahead of the body’s centre of gravity with the knee extending on heel strike
Undiagnosed restricted ankle joint movement causing dysfunctional movement – we also need to rule out a possible ankle posterior impingement issue
What conditions can cause pain in the Achilles region
Is it an insertional Achilles tendonopathy which is located towards the heel or a mid-tendon Tendonopathy which can be felt 2com up from the end attachment point of the tendon?
Peritendinitis – which is a reactive tendonopathy with swelling along the inside area of the Achilles tendon- a squeaky feeling noted when flexing and extending the ankle.
Irritated Superficial Bursa – that may be irritated by direct pressure from the ‘Lip of the shoe.
Retrocalcaneal Bursitis – which is the bursa (fluid filled sac) that sits between the Achilles tendon and its boney calcaneus attachment point. This becomes thickened and inflamed leading to pain.
Calcaneus or Heel Bone Fracture – which gives pain at night and with sitting.
Achilles tendon rupture which requires an orthopaedic surgeons opinion on whether if it should be treated with surgical repair or with wedged Boot management
Other possible conditions include; Gout, pseudo Gout, Reiter’s Syndrome, Psoriatic Arthritis, ankylosing Spondylitis and referred pain from the Lumbar spine
When treating Achilles Pain, The Practitioners needs to correctly diagnose the Heel Pain condition, and address the causes of the pain.
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy (MIAPT) and is based in Thurles.
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