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Talking Achilles Tendinopathy


By Columnist Andrea Castello – Biomechanical, Sports and Paediatric Podiatrist:


Everybody knows somebody who has had a problem with their Achilles Tendon (AT).  This structure is one of the most injured in runners and this injury is seen very often in the more recreational athlete.

It is important to understand that there are two major types of Achilles Tendinopathy.

  1. Mid-Portion:
    • This is the more common form.
    • This affects the tendon about 2.5-3cm above the insertion on the heel.
    • Generally caused by a sudden increase/change in load on the tendon.
  2. Insertional:
    • This is less common but can be more painful.
    • This is felt on the back of the heel bone itself, where the Achilles attaches.
    • Generally caused by a compression (squashing) of the tendon against the heel bone as the foot is brought back towards the shin (dorsiflexion)

Insertional Tendinopathy is much harder to “cure” and I would strongly encourage you seek professional advice if you have this problem.

In a nutshell, management of Achilles Tendinopathy is about two things.  The first is pain management the second is load management.  It is important to understand that, as a rule, the AT only begins to hurt when the demands placed on it are greater than its capacity to perform said demands.  This is why the AT doesn’t hurt when you don’t do anything.

My Tips on Managing Achilles Tendinopathy are:

Don’t Rest

Yes, you heard me correctly.  Rest is the worst thing for any tendon problem.  If you don’t load a tendon its capacity will diminish making it easier to aggravate when you need to use it.  Rather than resting, you should look to modify your activity.  I am a big fan of simple strength work in the early stages of Achilles Tendinopathy to build capacity.  Isometric calf raises are a fantastic way of building strength and reducing pain in a symptomatic AT.  Any quality healthcare professional will help you devise a suitable program.

Footwear/Heel Lift

Change to a shoe that has a higher stack/drop or place a heel lift inside your shoes.  The greater the fall/drop from the back of the shoe to the front, the less eccentric load (lengthening load) is placed on the AT.  Reducing this load on the tendon will reduce pain levels.

Training Environment

Get off hard ground and playing surfaces.  This aggravates Achilles problems.

Running Technique/Training Intensity

If you are a forefoot/midfoot striker or do a lot of high intensity work outs, it may be worth looking to change to a heel strike pattern, go for longer runs or move to low intensity workouts to reduce the load on the AT until you build capacity.

Seek Professional Help

If managed early, Achilles Tendinopathy can be resolved reasonably quickly.  If left, however, it can become a chronic problem which may take months to resolve.  A quality healthcare professional will guide you through the rehab process and get you back doing what you love, fast!

About Our Podiatry News and Review Columnist

AC Podiatry (19 of 20)Andrea Castello graduated from the University of South Australia in 1999 and has worked in the public and private sectors in both the country and the city. After completing a Masters Degree in Health Services Management in 2006, Andrea decided it was time to put his education to work and start his own practice, which culminated in the inception of AC Podiatry in late 2007. Since then it has grown to include 8 clinics employing 11 podiatrists.

As a podiatrist, Andrea has spent much of his professional career refining his skills with particular attention given to biomechanical, sports and paediatric podiatry. In addition to standard podiatric skills, Andrea has also completed numerous workshops in Dry Needling and Mobilisation. He is a member of Sports Medicine Australia, the Australasian Academy of Podiatric Sports Medicine, a Mentor to final year students and new graduates, and is currently the podiatrist for the Central District Football Club in the South Australian National Football League.

Disclaimer: The information published in this column are based on the author’s own professional and personal knowledge, and opinion. This information and opinion is not intended to be a substitute for professional medical advice, diagnosis or treatment of any manner. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding any medical condition and consult a qualified medical professional before beginning any nutritional program or exercise program. Never disregard professional medical advice or delay in seeking it because of something you have read on InShape News.


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