As your Achilles tendon is crucial to your ability to walk and run, treating Achilles pain effectively is a key focus area for our podiatrists.
Your Achilles tendon is the strongest and largest tendon in your body. It is connected to your calf muscles and attaches to the back of the heel bone. Your Achilles tendon is crucial for your ability to walk and run - taking on forces of up to twelve times your body weight during jumping. As such, the Achilles tendon and the structures around it can be injured when it is overloaded and strained during physical activity. This can make exercise and even simple daily tasks like walking up the stairs or standing on your tip-toes painful and, in severe cases, unmanageable.
What many people don’t know about the Achilles tendon is that compared to other tendons, it is notably slower and more difficult to heal as it has fewer vessels to bring blood to the area, and a good blood supply brings oxygen and nutrients for optimal repair. This is one of the reasons that we see so many longstanding Achilles injuries in our clinic, paired with not taking (and often not knowing) the right steps to best care for the tendon.
[The term Achilles tendinopathy is often used interchangeably with Achilles tendinitis and Achilles tendinosis to mean Achilles pain, although if we’re getting technical:
Tendinopathy: this is the most commonly used term, generally used to describe a tendon injury or problem without offering any insight about the cause behind it. The term “pathy” is derived from Greek denoting a disease or disorder. This is why many class tendinitis and tendinosis as a tendinopathy.]
Most cases of Achilles pain that our podiatrists see and treat come from either an overuse injury, or the degeneration of the tendon over time. Specifically, when the Achilles tendon is subjected to large amounts of force and strain beyond what it can safely physically handle, damage and micro-tears in the tendon can occur. In more serious cases, partial tendon tears or even complete ruptures may result.
Common activities that overload the Achilles tendon include:
In many cases we see, a patient may experience dull aches or niggles at the back of the heel and ignore these early signs in the hopes that the pain will resolve on its own. Unfortunately, without changing whatever is causing the overloading, the damage will progress and significant pain and injury will eventually begin.
Achilles pain may be caused by either the tendon or the structures close to the insertion of the tendon. Namely, four common diagnostic causes of Achilles pain that our podiatrists see and treat include:
1. Insertional Achilles Tendinopathy
Insertional Achilles tendinopathy describes damage to the Achilles tendon anywhere within 20mm of the point that the tendon attaches to the back of the heel bone. In the development of insertional Achilles tendinopathy, compression is often a key factor, occurring through movements like when the foot moves up (dorsiflexes) and pulls on and compresses the tendon.
Insertional Achilles tendinopathy tends to come with pain and tenderness directly at the back of the heel that is felt by pressing on the area of the bone where the Achilles attaches to. It is also common for bone spurs to form immediately above this insertion point and contribute to the pain. Achilles pain tends to increase with running or jumping sports and may also be associated with bursitis (see below) at the back of the heel.
2. Mid Portion Achilles Tendinopathy
Midportion Achilles tendinopathy means that the Achilles tendon has been damaged in the area above its insertion at the back of the heel, anywhere from 20mm to 60mm above this point. This is where the pain will be felt, and it may be elicited by pinching the cord-like tendon.
Unlike insertional Achilles pain which is related to compression, mid portion pain is often thought of as a tensile loading problem. Studies have also observed notable tendon degeneration when evaluating the mid portion of the tendon, suggesting that many cases of mid portion Achilles pain may be chronic with degeneration occurring over time.
Bursitis simply means the inflammation of a bursa - a small, fluid filled sac that sits between structures in the body to help prevent painful friction and rubbing, while promoting lubrication and healthy movement. When the bursa is overloaded, like from excess pressure from tendons (like the Achilles tendon) or other structures, they can become swollen and painful. This is known as bursitis. We have bursae all around our body, and there are two that sit at the back of the heel that can produce pain:
4. Haglund’s Deformity
A Haglund’s deformity is a bony enlargement (bump) that develops at the back of the heel bone. The bony enlargement itself is actually asymptomatic and painless - when symptoms present, they come from the surrounding structures like the Achilles tendon or the bursa at the back of the heel. The symptoms occur because the Haglund’s deformity can interfere with the natural movement or positioning of structures in the heel, leading to irritation.
The specific causes for a Haglund’s deformity is poorly understood, research on the topic does not present a clear cause or understanding as to why the particular bony section of the back of the heel becomes enlarged. It is often considered idiopathic, meaning that it can occur spontaneously.
Caring for your Achilles pain at home is focused around managing your symptoms to give you relief until you can book in with your podiatrist. You may be able to try:
If you’re experiencing Achilles pain your appointment will start with a comprehensive assessment to understand which structures at the back of the heel have been injured, and how and why this has occurred. Once we know this, our podiatrists will put together an evidence-based management plan that supports you in getting the best outcome for your pain and injury, while helping reduce the likelihood of the problem recurring in the future. This may involve:
In severe cases where your assessment indicated a significant tear or rupture of your Achilles (we would confirm this with ultrasound), we may need to immobilise the foot using a moon boot or CAM walker for the initial stages of your recovery.
Our team of trusted and knowledgeable podiatrists have a strong focus on the best approach to managing Achilles pain. We go above and beyond for our patients, and take the time to create treatment plans that meet your goals and lifestyle.