Achilles tendonitis is an inflammatory condition that involves the Achilles tendon and/or its tendon sheath. Achilles tendonitis is the most common overuse injuries reported in distance runners.Although Achilles tendonitis is generally a chronic condition, acute injury may also occur. Typically, the athlete will suffer from gradual pain and stiffness about the Achilles tendon region, 2 to 6 cm above the heel. The pain will increase after running hills, stairs, or an increased amount of sprints (running on toes). Upon evaluation, the calf muscles (gastrocnemius and soleus ) may appear normal however, flexibility will be reduced. Having the patient perform toe raises to fatigue will show a deficit compared to the uninvolved limb. Inspection of the area may feel warm to the touch and pain, tenderness and crepitus may be felt with palpation. The tendon may appear thickened indicating a chronic condition.
Healing of Achilles tendonitis is a slow process due to the lack of vascularity to the tendon, in other words the tendon does not have a lot of blood flow surrounding it. Resting and activity modification is important during the initially healing stages. The importance of allowing the tendon to heal must be emphasized. During this time, muscle release tecnhniques can be started to the area to break down adhesions and promote blood flow to the area.
Stretching and strengthening of the gastrocnemious-soleus complex should be incorporated as tolerated by the patient. Towel stretching and slant board stretching should be done throughout the day. Progressive strengthening including toe raises and resistive tubing should be incorporated at the beginning of rehabilitation. Sets should start low with low reps and gradually increase to low sets high reps for endurance as tolerated by the athlete. As pain and inflammation decreases, machine weights, lunges, and sport specific exercises can be added. Eccentric exercises for the calf muscles often have beneficial results in athletes with Achilles tendonitis.
The patient’s foot structure and gait mechanics need to be evaluated for possible orthotic benefits. Often Achilles tendonitis is a result of overpronation, an abnormality that can be addressed with foot orthoses. Once range of motion, strength and endurance has returned, athletes should slowly progress into walking and jogging program. Workouts should be done on a flat surface when possible. The walking and jogging program should start out with slow mini-bursts of speed. The program is to increase the amount of stress the Achilles tendon can tolerate; it is not to improve overall endurance. As tolerated by the patient, running and sprinting can be increased.
Return to Sport
Athletes should be allowed to compete when full range of motion and strength has returned. The athlete should have regained endurance in the involved limb and be capable of completing a full practice without pain. Depending on the sport, some athletes may be able to compete while suffering from Achilles tendonitis. However, patients should be educated in the fact that the condition will not go away without proper rest and treatment.
Patients need to be educated with the risks of Achilles tendonitis, specifically hill running, lack of proper shoes, lack of rest, and flexibility. Hill workouts increase the stress and strain to the gastrocnemius-soleus complex and Achilles tendon. Hill workouts should be done at a maximum once a week to allow the body time to heal. Similar to any chronic injury to the feet, shoes must be evaluated. Athletes need to learn and understand their foot type and the proper shoes for their foot type. Also, shoes should be replaced every 500 miles are a maximum 2 years. Running on old worn shoes will alter biomechanics and cause stress and strain to the body. Finally, the lack of flexibility is often the main culprit in Achilles tendonitis. The importance of stretching and stretching often should be emphasized.
For more information or for treatment inquiries contact drremy@thechiropracticoffice or call 905-820-7746
Clin Sports Med. 2010 January; 29(1): 157–167.
Rehabilitation of Ankle and Foot Injuries in Athletes