The Achilles tendon joins the calf muscle (Gastrocnemius) to the heel bone (Calcaneus) which is the largest and strongest tendon in the body; however, due to poor blood supply to the tendon, damage takes longer to heal than other soft tissue injuries.

Symptoms & Causes

Achilles tendonitis can present as pain anywhere along the tendon, localised warmth, mild swelling or pink/redness. Pain is intensified when you push up on your toes and lift your heel off the ground. This is due to the tendon contracting and being put under load. Achilles tendonitis is often worsened by:

• An increase in usual running distance
• Running uphill frequently which creates a repeated stretch on the Achilles tendon as the ankle is positioned in dorsi flexion (position where the toes point up towards the body)
• Pronation and over pronation. This is when the foot rolls inwards and the arch of the foot collapses, this position increases the strain on the Achilles and can cause injury
• Wearing high heels

Achilles tendonitis is a common overuse injury in athletes. The Achilles tendon can be put under stress from overuse of the calves in physical activities such as running and cycling. It is seen in runners who are doing excessive sprinting and speed work but not stretching enough when their calves are tight. Further to this, cyclists whom have their seat position too low are putting their Achilles tendon under stretch due to the foot and ankle being in a dorsiflexed position on the pedals.

Each time the Achilles tendonitis heals, it repairs with a small amount of scar tissue or adhesions. Adhesions will build up over multiple injuries to the Achilles tendon, making the tendon less flexible. Therefore, you should rest and treat the tendonitis as soon as possible. Here are some ways to prevent and treat Achilles tendonitis.

Treatment & Prevention

Stretching
It is important to always stretch the calves, hamstrings and Achilles to maintain strong and flexible leg muscles. One way to stretch the Achilles tendon is to stand with the knees very slightly bent, lean the body forward to reach for the floor. Take deep breaths in and as you exhale allow your body weight to move your torso closer to your knees and your hands will reach further towards your feet. You should feel an obvious stretch behind the knee. This is stretching the hamstrings and the calf muscles.
Another gentle stretch is keeping your feet and heels planted on the floor, shoulder-width apart whilst keeping the torso straight and upright, bend the knees forward. Aim to get your knees bending over the toes or further. This squatting position is stretching the Achilles nicely.

Footwear
If you have Achilles tendonitis, it is best to avoid wearing high heel as wearing heels puts the Achilles tendon in an excessively shortened position. This leads to premature tightness of the tendon and puts them at higher risk of tendon injury when you exercise. Ensure your running shoes are suitable for your foot type. It is important to wear shoes that support the foot and the motions made by the foot whilst running. If you are thinking of increasing your physical activity do it gradually to avoid stress or inflammatory injuries.

Heel Raises
In-shoe heel raises are suitable for pain relief in Achilles tendonitis. A heel raise is a wedge-shaped foam rubber insert, around 6-10mm in height and is placed in the shoe under the heel. Lifting the heel increases the ankle angle and slightly shortens the Achilles tendon to reduce the strain on the tendon. This allows the tendon to heal. You should also limit intense exercise when you have Achilles tendonitis to aid healing, as you risk putting impact and stress through the tendon which can increase the inflammatory response.

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