Achilles Tendinopathy
What is effective for Achilles tendinopathy… from an Achilles tendon specialist
What is Achilles tendinopathy?
Achilles tendinopathy is a common Achilles tendon injury. Injury to the Achilles tendon occurs in two areas: the mid-portion of the tendon and the insertion of the tendon to the bone. Mid-portion Achilles tendinopathy is typically seen in middle-aged long-distance runners, although it can also affect athletes in other sports.
How do Achilles tendon specialists diagnose an Achilles tendon injury?
Generally, people report experiencing pain in the Achilles tendon during activity. Achilles pain is usually inflammatory, i.e., it worsens after exercise. Morning stiffness is a common accompanying feature. When assessing a patient with an Achilles tendon injury, it is essential to inquire about factors that may have contributed to the injury, such as a sudden increase in training volume or intensity. Additionally, a biomechanical review is crucial for identifying factors that necessitate correction in Achilles tendon injury treatment. For example, calf weakness is an essential factor. Therefore, we should correct calf weakness as part of the treatment. Finally, doctors ask about other diseases that increase the risk of Achilles tendonitis, such as diabetes, high cholesterol, and certain medical conditions.
Imaging techniques, such as an 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 Achilles paratendonitis, Achilles tendon tears, posterior ankle impingement, and calcaneal stress fractures, which require different treatments. Generally, ultrasound has the advantage of being less expensive and can be performed simultaneously during 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 a rehab program. We recommend weighted calf raises for Achilles tendinopathy, tailored to individual needs. Generally, these exercises are best performed under the guidance of a physiotherapist expert.
Additionally, to support exercise, we utilise other treatments. For example, we believe that GTN patches aid in Achilles tendon healing. They are applied directly to the skin over the painful tendon. These patches reduce pain and improve response to exercise in Achilles tendinopathy. Similarly, we can use shockwave therapy in conjunction with exercise to enhance outcomes. Finally, on occasion, we use injections to aid in treatment. Dr. Masci has co-authored a review on ultrasound-guided injections for tendinopathy. It is essential to discuss the pros and cons of various injection treatments for Achilles tendon injuries, enabling patients to make an informed decision.
Finally, we only recommend surgery for a select few who have failed 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 tendon, making rehabilitation 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 with rehab. Ultimately, surgery should be reserved for cases that have failed other treatments.
