Achillodynia

A pain syndrome of the Achilles tendon

Achillodynia is a pain syndrome of the Achilles tendon

What is achillodynia and how does it develop?

Achillodynia is the pain syndrome of the Achilles tendon and the lubricating tissues surrounding the tendon. It generally develops following overstrain of the tendon. Unfit individuals, who have trained too hard, often suffer from achillodynia. But not only runners and other athletes are affected.

Overweight people also often have problems with the Achilles tendon. Rheumatism and foot deformities and other conditions can also be precipitating factors for achillodynia.

Anatomy

As the strongest tendon in the human body, the Achilles tendon (tendo calcaneus or tendo Achillis) transmits the power of the calf musculature to the foot. This facilitates the toe off of the foot when walking and running. When you run, for example, a force equal to eight times your own body weight acts on the Achilles tendon.1

Anatomy of the Achilles tendon
Achilles tendon

Risk factors and causes

The cause of achillodynia is mostly overstrain of the Achilles tendon. The risk factors are diverse.

Sporting activities

  • High running and jumping loads
  • Unusual stresses, for example, running on uneven or overly hard ground.
  • Inadequate fitness level

External factors

  • Unsuitable footwear
  • Smoking
  • Taking certain antibiotics

Anatomical factors

  • Reduced strength of the tendon with advancing age
  • Foot deformities  
  • Shortened tendons or muscles
  • Elevated uric acid levels
  • Rheumatic diseases
  • Overweight

Signs and symptoms

The clinical picture ranges from irritation to inflammation of the Achilles tendon. In some cases, the tendon can actually rupture. The symptoms express themselves as pain, increased warmth to touch and swelling of the Achilles tendon.

Initially the symptoms only occur when starting exercise and disappear again once you have warmed up. In the further course of the condition, the pain remains and the swelling no longer goes down.

Treatment of achillodynia

Initial treatment of achillodynia is always conservative, i.e. without surgery. The earlier treatment starts, the more successful it is. The following methods relieve pain and can slow or even stop progression of achillodynia.

  • Physiotherapy: special eccentric exercises2 can promote reorganisation of the tendon tissue. We recommend doing the exercises to strengthen the Achilles tendon and the leg muscles for several minutes twice daily. Depending on the findings and the phase of the condition, the doctor can prescribe further physiotherapy (therapeutic ultrasound), electrotherapy (TENS), transverse friction (special massage of the affected muscle or tendon fibres), shockwave therapy or acupuncture. 
  • Supports: special medical supports (for example Achimed from medi) can relieve stress and strain on the Achilles tendon. The interplay between the compressive knitted fabric and an integrated silicone pad, which exerts a gentle massage effect on the Achilles tendon, promotes the circulation to the surrounding tissues. This relieves irritation and pain. In the acute phase, patients can relieve their Achilles tendon further still with separate heel wedges that are worn in both shoes. 
  • Insoles: orthopaedic shoe insoles (for example, medi's igli Heel Spur Light) can correct the body's posture and relieve tension on the Achilles tendon.
  • Cold: mild cold treatments with cold packs relieve pain and swelling (refrigerator temperatures of about 7°).
  • Heat: a heat pad, a hot water bottle or massage with a warm towel roll (towel immersed in warm water) promote the circulation around the tendon insertion.
  • Medication: depending on the need and decision of the attending doctor, affected patients can take anti-inflammatory medication such as ibuprofen or diclofenac for one to two weeks. 
  • Ointments: anti-inflammatory creams or ointments can be massaged into the affected area several times a day. This promotes recovery.

The treatment should be planned individually for each patient together with the attending doctor, whereby his special needs and the exact clinical picture should be considered.

Central physiotherapy exercise

Eccentric training2 is an effective conservative treatment method for achillodynia. This has been shown by various studies3. Calf raises are considered the central exercise. (link down to the exercise description)

The exercise should be performed twice daily for a period of at least 12 weeks.

The exercise can be done very simply on a step (e.g. stairs) and does not require any other fitness equipment.

Important to know:

Pain in the calf musculature is to be expected during the first two weeks of performing the exercises, but have patience and conscientiously continue with them. If the pain becomes too severe, reduce the number of sets. If this doesn’t help reduce the pain or if you also have pain during your day-to-day activities, stop the exercises and please consult the doctor treating you.

All-in-one physiotherapy programme for achillodynia

Besides the central exercise calf raises, further additional exercises can be done to strengthen the Achilles tendon. medi has joined Dr Matthias Marquardt, sports doctor and active sportsman, to compile a training programme for this. The exercises can be done very easily at home. In the videos, Dr Matthias Marquardt teams up with the professional triathlete and physiotherapist Laura Philipp to show how the exercises are done correctly - ideally three to four times a week

Please ask your doctor first, whether the exercises are suitable for you.

Coordination - standing on one leg

Equipment: 

Stabilisation pad (alternatively: rolled-up towel, folded exercise mat)

Starting position:

  • Stand on one leg, barefoot and upright, on the stabilisation pad
  • Keep the knee of the leg you are standing on slightly bent
  • Lift the other leg up (one-leg stance) (Fig. 1)

Exercise:

  • The soft surface of the stabilisation pad creates instability - try to constantly compensate for this. 
  • This automatically activates your foot and hip muscles.
  • Please make sure your trunk muscles are tensed and that you maintain an upright posture. 
  • To do this tense your abdominal muscles and make yourself as tall as possible.

Variations:

  • Make the exercise easier by doing it on a hard surface (without the stabilisation pad)
  • Make it more difficult by drawing figures of 8 (with the free leg) (Fig. 2)
  • Make it more difficult by lifting the free leg up to the hip (Fig. 3)
  • Make it more difficult by closing your eyes

Dosing:

  • Three sets per leg, hold for 30 seconds in each case
  • Take a 15 second break between each set

Strengthening

Calf raises with straight knee

Equipment / Exercise location:

A stair tread (optionally with a handrail at the side)

Starting position:

  • Stand with the balls of your feet on the edge of a step
  • Your heels are suspended freely in the air

Exercise:

  • Keep your knees straight and stand on tiptoe
  • Lift the healthy leg up (Fig. 1)
  • Slowly lower the affected heel to below the level of the edge of the step (Fig. 2)
  • Now lift yourself up back to the starting position
    - keep your upper body upright
    - do not allow the affected leg to bend inwards (no knock-kneed position)

Variation:

  • Do the exercise with straight knees
  • Make the exercise more difficult by adding extra weight (e.g. a rucksack with weights)

Dosing: 

  • 3 sets with 15 repeats per set
  • Take a 15 second break between each set

Calf raises with bent knee

Equipment / Exercise location:

A stair tread (optionally with a handrail at the side)

Starting position:

  • Stand with the balls of your feet on the edge of a step
  • Your heels are suspended freely in the air

Exercise:

  • With your knees bent, stand on tiptoe (knee flexion approx. 60°)
  • Lift the healthy leg up (Fig. 1)
  • Slowly lower the affected heel to below the level of the edge of the step (Fig. 2)
  • Now lift yourself up back to the starting position
    - keep your upper body upright
    - do not allow the affected leg to bend inwards (no knock-knee position)

Variation:

  • Do the exercise with straight knees
  • Make the exercise more difficult by adding extra weight (e.g. a rucksack with weights)

Dosing: 

  • 3 sets with 15 repeats per set
  • Take a 15 second break between each set

Stretching - Calf rolling

Equipment:

  • Fascia roller (e.g. from Blackroll®)
  • Optional: exercise mat

Starting position:

  • Sit on the floor
  • Lift one foot and lay the calf of the other leg on the fascia roller
  • Lean back on your hands (Fig. 1)

Exercise:

  • Lift your bottom a little off the floor.
  • Now slowly roll over the whole length of your calf, forwards and backwards, i.e. from the Achilles tendon to the hollow of the knee.
  • You will now feel the pressure point treatment in your calf muscles.
  • Your trunk muscles support thereby the movement of your body (Fig. 2).
  • Point your toes downwards, so that your calf muscles are relaxed.
  • The exercise may be slightly painful at first, but the pain should never be more than you can easily tolerate.

Variation:

  • Make the exercise more difficult by rolling both legs
  • Make the exercise more difficult by crossing your legs

Dosing:

  • 3 sets with 10 repeats per set (roll forwards and backwards for each leg for the single-legged variant)
  • Take a 30 second break between each set

Products from medi

Supports

In case of pain in the Achilles tendon (achillodynia), the foot support Achimed helps relieve stress and strain on the Achilles tendon and thus reduces pain – without restricting the mobility of the ankle joint.

A silicone cushion that runs along the Achilles tendon exerts a gentle massage effect on the Achilles tendon and the surrounding tissues.

Click here for further information about our medi Achilles tendon supports.

Insoles

Orthopaedic shoe insoles (such as igli Heel Spur Light) can correct the body's posture and relieve stress and strain on the Achilles tendon at every step.

Click here for more information about our medi igli Heel Spur Light carbon insoles.

Sources:

1 Klein, C.: Orthopädie für Patienten [Orthopaedics for Patients]. Publisher: Michels-Klein, Remagen 2014

2 Eccentric training means loading a muscle or a tendon by slowing down a weight or resistance.

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