Achilles tendon injuries
Achilles tendon injuries are common especially in individuals who are physically active. The Achilles tendon is the largest tendon in the body, spanning from the heel to your calf muscle. It is easy to locate and feel, as a springy band of fascia at the back of the ankle. It is the most common tendon injury I see in my clinic. It is thought that injuries to the Achilles’ tendon are becoming more common secondary to a growing ageing population, increased BMI across the population and more individuals participating in activities straining the Achilles Tendon.
There are two main types of Achilles tendon injuries;
An acute complete RUPTURE can occur, which rarely is preceded with pain or symptoms.
The painful overuse injury with a slow onset. We call this a TENDINOPATHY.
Both types will require a specific loading exercise plan at some stage for a successful outcome.
What causes an Achilles rupture?
Achilles Tendon ruptures or complete tears happen very suddenly. A loud noise such as a gunshot, ‘pop’ or snapping is often heard at the time of the injury.
The area will usually swell immediately and a Thompson test performed by the Doctor or Physiotherapist would be positive. There is often a palpable gap at the area of the tear, but not always. An Achilles rupture can happen to anybody but is more commonly seen when there is a sudden ankle movement such as the push off for a sprint. Following rupture, you would have trouble pointing your toes and pushing off your toes when you take a step.
How to treat an Achilles rupture?
Conservative treatment or operative input can be successful in treating an acute Achilles rupture. Recent evidence has suggested that following either a conservative or surgical approach, the rehabilitation to follow is a crucial component of treatment and a successful outcome. The time period for return to sport following a complete rupture is around 6 months. As the time frame for returning to full function and activities is very similar between those having surgery compared to those being treated conservatively, many surgeons are moving towards the non-surgical approach due to the risks associated with surgery.
Physiotherapy plays an integral part following an acute Achilles rupture. A specific and structured rehabilitation plan should be designed for you to meet your goals.
What causes an Achilles Tendinopathy?
A tendinopathy at the Achilles will present with a much slower onset and is usually related to overload causing gradual thinning of collagen fibres. These will often present in individuals who have increased training or those who have gained a significant amount of weight. The most obvious sign is pain above your heel, especially when you stretch your ankle or stand on your toes. It may be mild and get better or worse over time.
There are other factors that can pre dispose an individual to an Achilles tendinopathy, such as;
> age due to the decreased turnover rate of collagen as we age
> increased BMI
> smoking
> lower limb biomechanics
> medications such as Statins, Corticosteroids and Fluroquinolones
> metabolic factors eg Diabetes
> hormone imbalance
> inflammatory conditions such as Ankylosing Spondylitis
How to treat an Achilles Tendinopathy?
Physiotherapy is essential to manage an Achilles tendinopathy. Goals in treatment are:
> to reduce pain
> promote tendon healing through a gradual loading plan
> improve muscle strength and endurance
> aid in recovery of the neuromuscular function
> make exercises sport specific
If you are suffering from what you think is an Achilles tendon issue, please do not hesitate to get in contact.
