INTRODUCTION
Achilles tendonosis is a condition that causes activity related pain to the back of the heel. It is more common in people involved in running sports with a higher incidence occurring as age increases. The pain of Achilles tendonosis may be felt at the bony part of the heel where the Achilles tendon inserts or it may be higher up the Achilles tendon itself.
ANATOMY
The large muscles of the calf join to form a common tendon called the Achilles tendon, which inserts onto the back of the heel bone. Injury can occur to the bony insertion of the Achilles or in the tendon fibres itself, usually about 2-6cm above the bone.
DIAGNOSIS
People with Achilles tendonosis often describe an insidious onset of pain at the back of the heel. Sometimes the tendon may be thickened or the bony bump may be swollen depending on where the pain is located. There is usually tenderness when palpating the heel.
INVESTIGATIONS
Medical imaging is not usually needed to diagnose Achilles tendonosis unless there is concern about tendon rupture.
TREATMENT
There are many treatment options for Achilles tendonosis ranging from pain relief to attempts at healing depending on the acuity and severity of the condition.
Pain Relief
- Ice – useful for acute pain
- Medications – Paracetamol and non-steroidal anti-inflammatory (e.g. Ibuprofen)
- Acupuncture
Exercises
Eccentric ‘heel drop’ exercises should be performed at least daily to mechanically load the tendon and provide a direction for the fibres to heal. Depending on the site and severity of the pain, the heel should drop either onto flat ground or over a step. Ask your sports medicine practitioner to show you how to perform these exercises.
Activity Modification
Patients with Achilles tendonosis may have to reduce or even completely cease the aggravating activity to adequately rest the injured tendon. In the meantime, other non-impact activities such as cycling, swimming or use of the aerobic cross trainer may be undertaken to maintain cardiovascular fitness.
Biomechanics
A flat foot, high arches or feet that roll in excessively may worsen Achilles tendonosis. It may be worth considering a pair of insoles or orthotics to help correct any abnormal foot biomechanics. Sometimes an orthotic with a heel lift may help unload the calf and Achilles tendon.
GTN Patches
Tendon injuries have a slow recovery time because they have a poor blood supply. Recent studies have shown that low dose GTN patches (usually used in patients with coronary heart disease) can help improve Achilles tendonosis.
Injections
Depending on the site of pain, a cortisone injection may provide short to medium term pain relief. Autologous blood and PRP injections are being used in the treatment of some forms of Achilles tendonosis. This involves the injection of the patient’s own blood into the Achilles tendon insertion.
Surgery
A small percentage of patients may require surgery for chronic and severe intractable pain.