what is Achilles tendinopathy?
Causes and treatments to resolve pain from Achilles Tendinopathy (Achilles Tendonitis)
The achilles tendon connects the calf muscles ( gastrocnemius muscle and the soleus) to the heel bone (calcaneus). 80% of achilles tendon pain is mid-portion meaning 2-3 cm above the heel bone due to a poor healing area from a lack of blood. 20% of achilles tendinopathy is insertional which is at the heel bone. Most achilles tendon injuries occur due to a a certain amount of overstress which causes micro-damage to the tendon. It is commonly seen in runners.
How do I know if I have achilles tendinopathy?
Patients report pain in the back of their heel. They report pain anywhere from the heel up to the mid calf. An MRI is not necessary and an ultrasound is equivalent to MRI and can be performed in the clinic in addition to a physical exam.
What are the treatment options for achilles tendinopathy?
Initial treatment options should include eccentric or heavy slow resistance strengthening which involve performing calf raises in a unique way depending on the type of achilles tendinopathy. Patients should do these exercises consistently every day over 12 weeks as reported in Alfredson rehabilitation protocols.
If physical therapy does not improve your pain or ability to perform activities, the next step is to consider injection. There are cortisone injections and orthobiologic injections. Cortisone can be injected into the fat pad or bursa to decrease inflammation but should not be injected into the tendon.
Other injections to consider are orthobiologics. Orthobiologics include Platelet Rich Plasma (PRP). Please speak with your physician to see if you are a candidate with these procedures. They can help with reducing pain and increasing function.
Other treatment options that can be helpful include Tenex or tendon scraping. Learn more about tenex here. Tendon scraping is using a tool to separate the tendon and the fat pad so the tendon can glide easier.
If injections do not provide relief, the next procedure to consider is tendon repair. This is where they stitch the tendon back together.
Ankle/Foot Research:
https://pubmed.ncbi.nlm.nih.gov/28399635/
https://pubmed.ncbi.nlm.nih.gov/29909689/
