Achilles Tendon

The Achilles tendon is a dense fibrous band that connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus).  The Achilles tendon allows the calf muscles to pull on the heel causing the foot to plantar flex.  This pulling motion allows us to stand on our tiptoes.  The Achilles tendon is the strongest and largest tendon in the body and endures considerable force when walking, running or jumping.  In spite of the Achilles great strength, the tendon can be quite vulnerable to injury.  This is because it has a limited blood supply and is often overused taking high forces and repetitive motions.

Cause of Injury

Achilles tendinitis is a common injury in sports that involve lunging and jumping.  Swelling and disorganized collagen occurs immediately due to microtears or partial tears.  This can be detected through visual inspection or physical touch.  The Achilles tendon will appear red and will radiate heat.  Diagnostic imaging is typically not necessary for diagnosis but can confirm tearing and increased water content around the tendon. 

The pain involved with Achilles tendinitis is usually worse during and directly after exercise.  Stiffness will follow around 24 hours after exercise.

Passive Treatment of Achilles Tendinitis

Low-level laser therapy:  Involves the use of light to speed up chemical reactions in the body.  Speeding up these reactions helps to decrease healing time and reduce inflammation.

Soft tissue therapy:  Soft tissue work can be accomplished by hand or instrument assisted.  Both muscle and tendon stripping should be combined with passive stretches.  This form of treatment will help align the muscle and tendon fibers. 

Transcutaneous electrical nerve stimulation (TENS):  TENS is an electrical current that is applied to the body through wetted sponges or sticky pads.  Treatment with TENS has a great pain relieving effect although is uncomfortable at the time of application.  TENS also causes the muscles under the pads to contract helping to pump out excess inflammation.

Acupuncture:  During the acute stage of an Achilles injury acupuncture can help with pain relief.

Active Treatment of Achilles Tendinitis

Relative rest:  It is important to rest the Achilles after an acute injury, but too much rest can be detrimental to the healing process.  The muscle needs to move and stretch to help pump out inflammation, align muscle and tendon fibers and ensure scare tissue heals in the proper lines of stress.

Ice:  The application of ice 10 minutes on, 10 minutes off and 10 minutes on again can help reduce the chemical irritation that inflammation brings.  Do not leave the ice on for longer then 15 minutes.  After this time the body forces more blood flow to the area.

Compression:  Gentle compression will help squeeze inflammation away from the Achilles tendon.  Be careful not to leave a tight compressive band on over night.  This could block blood supply and permanently injure the foot.

Elevation:  Keeping the foot and leg elevated will also help decrease inflammation in the area and reduce the throbbing pain it can bring.

Stretching:  Adding tension to the muscle through stretch will help align the muscle and tendon fibers.  Since the injury involves tearing stretching can help decease the chance of permanent stiffness and decreased range of motion through the ankle.  A simple exercise that can be done from the comfort of your home is the calf towel stretch.  This involves wrapping a towel around the ball of your foot and pulling your toes toward your nose.  Hold the stretch for 30-45 seconds and repeat 8-10 times in a row.

Heel lift:  Placing a small heel lift into the back of your shoe elevates your heel taking pressure off the inflamed Achilles tendon.  This is great for temporary pain relief after an acute injury.

The above active therapies can be done independently, however, incorporating some of the passive therapies with a chiropractor or physiotherapist will greatly decrease healing time and get you back in the game.