Achilles Tendon Disease

Achilles Tendon Disease 

Have you ever had pain in the back of your heel during or after doing a sport activity you enjoy?

Do you feel that the first steps in the morning are stiffer, more difficult?

Have you taken advantage of the good weather to keep your days "a little too busy" between zumba classes, tennis matches and hiking in our beautiful regions of Quebec?

If you answered yes to these questions or if you have experienced heel pain that can limit your activities, you may have Achilles tendon disease.

 

Description of the pathology

This type of problem is often related to overuse or the overload of the Achilles tendon. This can occur with the practice of repeated movements without adequate rest periods or by trying an activity that we are not used to. This leads to an inflammatory process that makes the tendon more sensitive to the different stresses that are subsequently imposed on it. In some more chronic cases, the structure of the tendon changes and it is less able to tolerate mechanical stresses (for example, walking, running, jumping).

This pathology is quite frequent in runners (approximately 36% of them will present this type of pain during their life), but it is even more frequent in people who have recently started to play sports again, particularly between 30 and 50 years old.

 

Possible causes

- Too rapid an increase in the volume of physical activity

- Poor foot biomechanics (collapse of the plantar arch, excessive pronation)

- Decreased strength/flexibility of the soleus and gastrocnemius (calves)

 

What can I expect to heal?

Numerous studies on the subject have shown that 90 to 95% of Achilles tendonopathies are resolved with conservative treatment (physiotherapy and the treatments mentioned below). The surgical approach is quite rare and not encouraged for this pathology. On average, the recovery time varies between 3 to 6 months and depends largely on the adoption of an adapted rehabilitation program (exercises, stretching, gradual resumption of sports, etc.). It is therefore necessary to be very patient, but the efforts are worth it!

 

Why consult a physiotherapist?

The physiotherapist can evaluate with you the factors that may have led to this tendon overload, by discussing your lifestyle and your physical activity habits in order to give you advice and exercises adapted to your condition so that you can quickly return to your favorite activities!

He will ask you about your training habits, the factors that influence your recovery (sleep, stress, rest) and the type of shoes you wear.

Then, he will evaluate the strength and flexibility of your calves, the mobility and stability of your ankles, etc. in order to find the source of the problem to properly coach you.

 

*It should be noted that a strong and resistant Achilles tendon allows for improved performance in power sports such as running and jumping sports (volleyball, basketball, etc.) since its elastic structure allows it to store energy like a spring when the foot makes contact with the ground.

 

General recommendations while waiting for your physiotherapy appointment

-Apply ice for 10-15 minutes on the Achilles tendon after your activities

-Stretch your calves progressively every day

-Do circulatory exercises (point your foot up and then down) several times a day

-Take 2 days off from activities that cause pain in the back of the ankle.

Recommended treatments

Strengthening exercises: A must in the healing of Achilles tendon, any rehabilitation program should include strengthening exercises, especially eccentric (contraction while the muscle is stretching). Strong and healthy calf muscles (gastrocnemius and soleus) are an important healing factor in the management of this tendinopathy.

Quantification of mechanical stress: The tendon must adapt to the stresses placed on it. It is essential to reduce the load on the tendon by first reducing our activities. Then, it is necessary to impose a progressive load on the tendon in order to improve its capacity to adapt to mechanical stresses (e.g.: start walking, jogging, running gradually). The management of activities represents the best factor of success in the treatment of this pathology.

Stretching: Stretching has been shown to have a positive effect on pain management, improved function and healing of the Achilles tendon when used in combination with mobility and strengthening exercises.

Foot orthotics: Used primarily at the onset of pain to reduce the impact of pain on activities. It is important to gradually stop wearing them when symptoms diminish.

Taping: Allows to reduce pain and to provide some support to the ankle and foot. Can mimic the effect of a foot orthosis.

Cortisone injections: Not recommended for this type of problem! According to several studies, this increases the risk of tearing the tendon.

Shock wave therapy: Used for chronic cases. Effective for patients who have been in pain for 6 months and for whom prolonged conservative treatment has failed.

 

*We recommend that you begin treatment with a physiotherapist in order to have an exercise program adapted to your needs.

 

Maude Després-Côté, physiotherapist

•       Beyer, R., Kongsgaard, M., Hougs Kjaer, B., Ohlenschlaeger, T., Kjaer, M., & Magnusson, S. P. (2015). Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy: A Randomized Controlled Trial. Am J Sports Med, 2015

•       Habets, B., van Cingel, R.E.H., Backx, F.J.G. et al. Alfredson versus Silbernagel exercise therapy in chronic midportion Achilles tendinopathy: study protocol for a randomized controlled trial. BMC Musculoskelet Disord, 2017

•       Jarin, I., Bäcker, H. C., & Vosseller, J. T. (2020). Meta-analysis of noninsertional Achilles tendinopathy. Foot & Ankle International, 41(6), 744-754.

•       Khan, Karim & Cook, Jill., Overuse Tendon Injuries: Where Does the Pain Come From?. Sports Medicine & Arthroscopy Review, 2000

•       Longo, Umile, Ronga, Mario, Maffulli, Nicola, MD, MS & PhD, FRCS., Achilles Tendinopathy. Sports Medicine & Arthroscopy Review, 2009

•       Rowe, V., Hemmings, S., Barton, C., Malliaras, P., Maffulli, N., & Morrissey, D. (2012). Conservative management of midportion achilles tendinopathy. Sports medicine, 42(11), 941-967.

•       Silbernagel K, Thomee P & Karlson J., Eccentric overload training for patients with chronic achilles tendinopathy - a randomized controlled study with reliability testing of the evaluating methods. Scandanavian Journal of Medicine and Science in Sports, 2001

•       Stanish W. D., Rubinovich R. M., Curwin S. Eccentric Exercise in Chronic Tendinitis. Clin. Orthop. Relat. RES, 1985

•       Van Der Vlist, A. C., Winters, M., Weir, A., Ardern, C. L., Welton, N. J., Caldwell, D. M., ... & De Vos, R. J. (2021). Which treatment is most effective for patients with Achilles tendinopathy? A living systematic review with network meta-analysis of 29 randomised controlled trials. British journal of sports medicine, 55(5), 249-256.

•       Wilson, F., Walshe, M., O’Dwyer, T., Bennett, K., Mockler, D., & Bleakley, C. (2018). Exercise, orthoses and splinting for treating Achilles tendinopathy: a systematic review with meta-analysis. British Journal of Sports Medicine, 52(24), 1564-1574.