Achilles Tendinopathy

What is effective for Achilles tendinopathy… from an Achilles tendon specialist

What is Achilles tendinopathy?

Achilles tendinopathy is a common injury Achilles tendon injury. Injury to the Achilles tendon occurs in two areas: mid–portion of the tendon and insertion of the tendon to the bone. Mid portion Achilles tendinopathy is typically seen in middle-aged long-distance runners, although it can affect other sportspeople. Generally, an Achilles tendon specialist has expertise in managing this condition.

How do Achilles tendon specialists diagnose an Achilles tendon injury?

Generally, people report pain in the Achilles tendon occurring with activity. Pain is inflammatory, i.e., warming up with exercise but worsening after activity. Morning stiffness is a common accompanying feature. When assessing a patient with an injury to the Achilles tendon, it is essential to ask about factors that have led to injuries, such as a sudden increase in training volume or intensity. Additionally, a biomechanical review to detect factors needing correction is essential to Achilles tendon injury treatment. For example, calf weakness is a crucial factor. Therefore, we should correct calf weakness as part of the treatment. Finally, ask about other diseases that increase the risk of Achilles tendonitis, such as diabetes, high cholesterol, and antibiotics.

Imaging such as ultrasound or MRI scan can help diagnose Achilles tendinopathy. Tendon thickening and breakdown of collagen proteins are typical changes we see. Imaging is also necessary to rule out other diseases, such as paratendonitis or an Achilles tendon tear, which require different treatment. Generally, ultrasound has the advantage of being cheaper and performed simultaneously as a consultation.

What treatments do tendon specialists advise for mid portion Achilles tendinopathy? 

Once we confirm a diagnosis of an Achilles tendon injury, most people perform an exercise program. For example, we suggest weighted calf raises for Achilles tendinopathy, which we tailor to individuals. Generally, these exercises are best performed together with a physiotherapist expert.

Next, to help with exercise, we use other treatments. For example, we think GTN patches help with Achilles tendon healing. They are applied directly to the skin on top of the painful tendon. These patches reduce pain and improve response to exercise in Achilles tendinopathy. Similarly, we can use shockwave therapy alongside exercise to help outcomes. Finally, on occasion, we use injections to help. Dr. Masci has co-authored a review on ultrasound-guided injections for tendinopathy. It is essential to discuss the pros and cons of different injections for an injury to the Achilles tendon so that patients can make the correct decision.

Finally, we only recommend surgery for a few who fail other treatments. For example, recent studies by Dr. Masci reveal that a small number of patients with Achilles tendon injuries have a thickened plantaris tendon. This tendon could interfere with the Achilles making rehab less effective. These cases may need early surgery.

Final word from Sportdoctorlondon about Achilles tendinopathy

Achilles tendinopathy is common in middle-aged runners but can affect a broad spectrum of sportspeople. Warming up pain at the site of tendon swelling is a common finding. Generally, treatment should consist of rehab to strengthen the calf muscle. In addition, we use other therapies such as GTN patches, shockwave therapy, or injections to help rehab. Finally, surgery should only be reserved for cases that fail other treatments.

Dr. Masci is a specialist sport doctor in London. 

He specialises in muscle, tendon and joint injuries.