Tendinopathy of the Achilles tendon (AT) usually causes pain around the posterior (rear) aspect of the foot and can be at the insertion (where it attaches onto the bone) or midportion (along the body of the tendon). There can be associated swelling, redness, stiffness and difficulty with mobilising, particularly when standing on your toes or walking up and down stairs.
What causes it?
Tendinopathy can arise for different reasons, but it is usually due to an increase in activity, either from doing none at all or a sudden increase without progressive loading. Alternatively, if there is change in footwear, training style or even running route, these can all trigger off they symptoms. Continuing with the same pattern can lead to the problem becoming more chronic in nature.
How can I help myself?
It is useful to think back to how the symptoms came on and what might be continuing to aggravate it. Sometimes, if it is due to running technique or tightness, then working with a coach or sports therapist can be helpful.
If there is considerable pain or swelling, offloading with crutches will reduce exacerbating it and also measures such as PRICE can help to reduce swelling. Pain killers can make the symptoms more tolerable.
When to seek help?
If you are having significant symptoms, particularly difficulty with walking or running, or despite the self-measures to improve things your symptoms are ineffective, it would be good to have your problem assessed.
What are the treatment options?
Once your clinician assesses you with a thorough history and examination, they may undertake an X-ray to look for bony changes, or an ultrasound scan to look at the AT itself.
Treatment with rehabilitation and a running gait analysis can suffice for many people with an additional focus on footwear, stride and cadence. In some situations, further treatment with extracorporeal shockwave therapy may be warranted, but if this is not improving symptoms then an MRI may be needed, with further consideration of PRP or prolotherapy injections.