Achilles Tendinopathy

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

What is Achilles tendinopathy?

Achilles tendinopathy is a common injury affecting the Achilles tendon. The injury occurs in two areas of the tendon – mid-portion of the tendon and insertion of the tendon to the bone. Typically, this condition is 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 Achilles tendinopathy?

Generally, people report pain at the Achilles tendon occurring with activity. Pain is inflammatory ie warming up with activity but worsening after activity. Morning stiffness is a common accompanying feature. When assessing a patient with Achilles tendinopathy, it is important 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 that need correction is an important part of treatment. For example, calf weakness is an important factor. Therefore, we should correct calf weakness as part of treatment. Finally, asking about other diseases that increase the risk of tendonitis such as diabetes, high cholesterol, and antibiotics is important.

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 important to rule out other diseases such as paratendonitis or a tendon tear, both of which require different treatment.  Generally, ultrasound has the advantage of being cheaper and performed at the same time as the consultation.

What treatments do Achilles tendon specialists advise?

Once we confirm a diagnosis, most people perform an exercise program. For Achilles tendinopathy, we suggest weighted calf raises, 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 tendon healing. They are applied directly on the skin on top of the painful tendon. These patches reduce pain and improve response to exercise in Achilles tendonitis. Similarly, we can use shockwave therapy alongside exercise to help outcomes. On occasion, we use injections to help. Dr Masci has co-authored a review on ultrasound-guided injections for tendinopathy. It is important to discuss the pros and cons of different injections so patients can make the correct decision.

Finally, we only recommend surgery in a small number who fail other treatments. For example, recent studies performed by Dr Masci reveal that a small number of patients with Achilles tendinopathy 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

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. We use other treatments 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.

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