Achilles Pain

Categories: Foot and ankle.

Pain in the back of the heel or along the tendon leading up to the calf muscles is a problem for runners and non-runners alike. 

In runners, Achilles problems can be associated with training loads that are above what is normal for that athlete. However, the most common problem causing achilles pain is an over-pronation of the feet (flat feet). Poor control of ankle and foot mobility causes the achilles to repeatedly bend while under tension placing increased stress on the tendon tissue. Imagine a rope placed under a microscope. As it’s put under tension, some of the fibres start to break. This can happen in the tendon and cause pain and inflammation of the tendon. Pain is usually localised to the area of injury on the achilles. This can be at the top end where the tendon tissue starts to merge with muscle tissue, on the tendon’s insertion point into the heel bone or at mid length of the tendon, approximately 2 inches above the base of the heel bone.

There are many ways to treat achilles issues that will depend on why the tendon has become irritated in the first place. Acutely pain and inflammation of the tendon should be managed with ice packs and anti inflammatory medication such as Ibuprofen.

Managing activity level and stress placed on the tendon is extremely important. Continuing on with activities through pain is often a bad thing to do and may cause further damage to the tendon. Maintaining some degree of activity is important in rehabilitating the achilles but continual overloading of the tendon will just make the recovery process a longer one.

Physiotherapy can help by optimising the stress and tension on the tendon. This may include massage, taping techniques, orthotics or possibly acupuncture. Your physio will also help to ensure a good quality scar within the achilles tendon by providing a suitable home exercise programme that adequately loads the tendon and stretches the scar tissue. 

Try these techniques to help reduce the tension of the achilles tendon;

 

  1. Add a heel raise to your shoe. Placing an insert under your heel within your shoe helps to reduce the stress on the achilles while it is acutely painful. This can be removed as pain starts to settle.

 

2. Massage the calf muscles. You can do this with a rolling pin or a foam roller. If using a rolling pin, while standing, place your foot on a chair and roll the rolling pin down the calf muscle in the back of the shin being careful not to roll onto the sore achilles near the ankle. Search for more tender knotted areas within the calf muscle itself and massage them for 1-2 minutes each day. If using a foam roller, roll your calf over it for 1-2 minutes trying to relax the muscle as you do so. This can be difficult at first as it tends to be quite tender to massage but will get easier the more you do it.

3. Stretch the Hamstring. Lie on your back with the knee above the hip. Hook a towel or a belt around the foot and pull the foot towards you, straightening the knee until you feel about a 7/10 discomfort stretch in the back of the leg. Hold that position for 20-30 seconds. Try 10 stretches each day while the muscles are warm. After a short walk or bike ride is good.

Then, book an appointment with your physio to start a structured treatment plan.