The Achilles tendon is a tough fibrous band of tissue (tendon) that runs down the back of the leg and inserts into the base of the heel bone (calcaneus). It attaches the calf muscle to the heel bone.
Achilles tendinopathy is a common condition that causes pain in the back of the heel HOWEVER, it is not the same as Achilles tendonitis.
“For many years all Achilles tendon pain has been referred to as ‘Achilles Tendonitis’, which refers to an ‘inflammation of the tendons’—causing a deep nagging pain, swelling and inflammation.
“Yet in most cases we’re seeing degeneration of the tendon, referred to as tendinopathy. This is described as a breakdown of tissue in the tendon, often caused by long-term overuse. While at times there may be signs of some inflammation, deterioration of the tendon generally presnts without any inflammation but it can be still painful,” explains podiatrist Dr Brenden Brown.
Symptoms of Achilles tendinopathy can vary from person to person but can include:
- Pain – usually on taking the first step in the morning
- Pain after standing for long periods
- Pain that can be lasting and debilitating
- Pain may be accompanied by swelling and tenderness
- Pain on compression (shoes and tight garments)
“It’s important not to assume that inflammation is present, as this will lead you down the wrong treatment path and prolong the pain,” adds Dr Brenden.
While there are numerous treatments for Achilles heel pain, many are now considered ineffective. Let’s start by addressing some common myths.
Rest is not best
It’s far better to keep moving than to rest up. Tendons hate change; if you stop doing activity due to Achilles tendinopathy the pain might go away initially, but once you resume activity the pain will no doubt return. Instead, continue with your regular level of activity in consultation with a sports podiatrist.
Similarly, prescribing an immobilisation boot (moon boot) to treat Achilles tendinopathy is outdated advice for exactly the same reason that ‘rest’ is not recommended!
Stretching won’t cure your Achilles pain
Stretching as a treatment modality for Achilles pain is archaic. Stretching simply pulls the Achilles at the point in which it goes into the back of the heel, putting additional pressure on the tendon and causing further irritation.
It also pulls the achilles over the posterior (back) of the calcaneus (heel bone), which further irritates the tendon. As a general rule, if the activity does NOT increase your pain and does not irritate the tendon—it’s safe to continue.
Steer clear of cortisone injections
Aside from being incredibly painful, evidence suggests that cortisone is of no use in treating Achilles tendinopathy.
In some cases cortisone may provide a temporary fix but it doesn’t address the underlying problem. As the injection wears off the pain often comes back significantly worse. Plus, the more injections you have, the more likely you are to rupture the tendon as they may, on occasion, weaken the junction where they join the bone.
Don’t waste your money on anti-inflammatories
While some inflammation may be present, not all Achilles pain causes inflammation. If there’s no inflammation, there’s no point in taking anti-inflammatories!
Now let’s look at a few ways you can successfully address your Achilles heel pain.
Hack #1—Perform isometric strength exercises
While stretching is of no use for Achilles heel pain, isometric strength exercises can be beneficial.
- Stand up straight, holding onto a bar or supportive surface;
- Raise both heels up so you’re on your tiptoes
- Lower both heels down half a centimetre
- Hold for 20 seconds.
NOTE: If you wobble, drop down and don’t raise heels up and down; this is a static movement.
Once you are able to comfortably hold the raised position for 20 seconds, progress (by a couple of seconds a day) to about 45 seconds
Finally, move to single leg heel raises. Stand on one leg (make sure you’re holding on to something for balance), bend the leg you’re standing on, raise the heel making sure your knee is directly over foot, lower the heel half a centimetre and hold.
Do the same on the other leg and build up the length of time you are holding for.
Hack #2—Heel raisers
Heel raisers are really helpful for Achilles heel pain as they temporarily offload the tissue, providing great relief. We recommend starting with about a half a centimetre heel raiser but for best results have a podiatrist assess your individual need and adapt your shoes to suit.
Achilles tendinopathy is not completely inflammatory, but in cases where inflammation and swelling is present, ice can be useful. We recommend ice immersion, as opposed to using an ice “pack”.
- Take a bucket of cold water (NO ice yet)
- Put your foot in the bucket (making sure it covers the entire area including above the injured area up the calf)
- Grab a bag of ice and add one cup to the bucket of water
- Wait for 2 minutes
- Add another cup of ice, wait for 2 minutes and so forth
- Once you feel like you want to pull your foot out (because it’s so cold)– leave it in for 20 minutes.
- Pull the foot out for 20 minutes
- Repeat another twice (three immersions in total).
- Do this for 4-7 days.
Think you have Achilles tendinopathy?
A Step Ahead Foot + Ankle Care is based in Western Sydney. We have multiple practitioners with loads of experience in treating Achilles heel pain.
If you’d like more information please contact our helpful front desk team. They are brilliant at working through what help you need, guiding you to the appointment that is right for you or your family, running through cost and then reserving your appointment time. Call us today on +61 2 9673 2987. We look forward to helping.
Facebook live sessions: