Description:

The Achilles is the largest tendon in the body and connects the calf muscles to the heel bone (calcaneus). Achilles Tendinitis (A.T.) is inflammation (-itis) of this tendon. The inflammation can either occur where the Achilles inserts into the calcaneus (insertional Achilles Tendinitis) or in the middle portion of the tendon (non-insertional Achilles Tendinitis).

Symptoms:

Pain and stiffness along the Achilles Tendon in the morning

• Pain on the back of the heel that worsens with activity
• Increased pain the day after exercise
• Thickening or swelling of the tendon
• Bone Spurs (Insertional Achilles Tendinitis)
• If you experience a sudden “pop” in the back of your calf or heel, you may have ruptured the achilles tendon. See a doctor or physician immediately.

Causes:

• Poor Foot Biomechanics: Pronation is a necessary function of the foot. Pronation allows the foot to disperse shock, reduce the impact felt on the body up the chain, and adapt to the surface of the ground. However, overpronation is an excessive amount of pronation in which the arch can collapse with each step. Overpronation can cause the foot to flatten out and the Achilles tendon to be pulled and stretched more than normally, which over time can cause irritation. Conversely, if the foot does not pronate enough, due to either a rigid foot or an overly supportive shoe or insert, increased impact will be felt up the chain, increasing stress on muscles, tendons, ligaments, and joints throughout the leg.
• Improper Footwear: If you overpronate, your arch tends to collapse as you walk or run. Putting a medial arch support under your foot doesn’t allow the foot to flatten, which leads to less stress on the Achilles tendon. If you have a rigid foot, you may want to avoid shoes that are overly supportive and don't allow adequate pronation to occur. Being in a shoe that does not match the shape of your foot can either cause your foot to hang off of the platform or have too much extra room inside the shoe. Both of these can lead to excessive movement and stress the Achilles tendon.
• Change in Footwear: The drop of a shoe is the difference between the height of the heel and the forefoot. A sudden and drastic decrease in the drop of a shoe can cause the Achilles to stretch more with every step, causing it to become irritated and inflamed over time. Spending a large amount of time in a shoe with a very high drop can also shorten the Achilles, increasing the likelihood of injury.
• Overuse: Achilles Tendinitis occurs from repetitive stress of the Achilles tendon. Whether you started a new job that requires you to walk around more or you’ve started a new exercise program, it is likely that the Achilles tendon is being stressed more than usual. Non-insertional A.T. typically occurs from repetitive contraction and extension of the Achilles with more active people. Insertional A.T. can occur in people who are less active and is typically more of a biomechanical issue.
• Tight Calf Muscles: You have two calf muscles (Gastrocnemius and Soleus) which connect to your Achilles tendon. The main jobs of the calf is to plantar flex the foot (push off on your toes) and stabilize the lower leg when the foot is on the ground. The Achilles tendon attaches on the back of that heel bone. If the calf muscles are too tight, they will pull on the Achilles tendon, increasing the stress at the insertion point on the heel bone and causing it to become irritated and inflamed.
• Age: There is a decrease in the elasticity of tissue as we age. As the tissue tightens up, there is more pull at the insertion point on the calcaneus.

Note: If Achilles Tendinitis is not properly treated, it could lead to Achilles Tendinopathy. We always recommend seeing a physician or attending our Injury Clinic on Wednesdays from 5:30-7:00pm for more information.

Other considerations:

• Achilles Tendinopathy is a structural change in the Achilles tendon as a result of long-term repeated stress without treatment. While the symptoms and treatments are often similar, Tendinopathy is much more difficult to reverse and requires a more substantial and personalized treatment program.
• Calcaneal Apophysitis (Sever’s) also presents as insertional Achilles Tendinitis in adolescents between the ages of 8 and 14. There is a growth plate in the heel that can become inflamed with activity, tight muscles, growth spurts, or improper footwear. (See Sever’s injury article)
• In both non-insertional and insertional Achilles Tendinitis, damaged tendon fibers may also calcify (harden).
• Bone spurs (extra bone growth) often form with insertional Achilles tendinitis.

Self treatment options:

• Support: If overpronation is determined to play a role, shoes with a supportive medial arch can help stabilize the foot and joints up the chain, relieving stress on the Achilles tendon. You might consider adding removable insoles (i.e. Stabilites, Orange Insoles, Powersteps) to shoes you currently have that might not be supportive enough. Adding a lift to your shoe or getting a shoe with a higher drop may also reduce the amount the Achilles stretches and reduce irritation.
• Stretching: Calf stretches and rolling: It is important to address the tight calf muscles. See below for Gastrocnemius and Soleus stretches as well as foam rolling techniques.
• Strengthening: Once the pain begins to subside, it is important to strengthen the foot and lower leg to prevent the symptoms from returning. Additionally, if the calves and Achilles are tight, the opposing muscles are typically weaker. Strengthening the shin muscles on the front of the leg can help to gain length in the calves, alleviate tightness, and increase ankle range of motion.
• Rest: “Play it by pain” – use pain to dictate your level of activity.
• Free Clinics: Most people walk and run in a way that puts excessive braking and friction on their joints, muscles, and tendons. Take a FREE Good Form Running and/or Good Form Walking clinic to have your form analyzed! Our Stretch, Strengthen, and Roll class will cover common muscle imbalances and how to correct them.
• Products: Insoles, Foot Rubz, Trigger Point Therapy massage ball, Addaday roller, Plantar Fasciitis compression sleeve or socks.

Exercises

Dorsiflexion with Resistance Band:

Tie one end of a resistance band to a stationary object and the other to your forefoot. Dorsiflex the foot by slowly pulling the forefoot toward your shin. Hold for 3-5 seconds and slowly let the band pull the foot back to a plantarflexed position. Repeat 15-20 times per foot multiple times per day. Progress by using a stiffer band, performing the movement more slowly, and dorsiflexing the toes throughout the exercise.

Heel Drops:

Stand on the edge of a step, stand tall with your abdominals pulled in, balls of your feet firmly planted on the step and heels over the edge. Slowly lower your heels, resisting gravity, until your calves are fully extended and your foot will not dorsiflex anymore. Then slowly raise the foot back to level. It should take 4-6 seconds to go in each direction. Progress by moving to a single leg and then holding light weights.

Shuffle (Heel) Walks:

This will help to strengthen the antior (shin) muscles to assist with dorsiflexion and help gain calf length. Begin by dorsiflexing your foot (pulling it toward your shin). With your foot dorsiflexed, walk forward on your heels 30 steps, then turn around and walk back. For increased difficulty, dorsiflex the toes as well and walk for longer distances.

Dorsiflex foot

Walk Forward on Heels

Single Leg Balance:

Balance on one foot for 30 seconds while barefoot. If this is too easy, close your eyes and tilt your head back! Advance to single leg squats by bending your knee, being sure it does not drift to the inside and the hips remain level.

Calf Stretches:

Gastroc: Stand with your right foot back. Keep your knee straight, and forward leg bent. Keeping your heel planted on the floor, toes facing straight ahead, lean forward from the ankles toward the wall. Hold for 30 seconds, and then switch legs

Soleus: Stand with your right foot back. Put a slight bend in your back knee, and forward leg bent. Keeping your back heel planted on the floor, toe facing straight ahead, lean forward from your ankles toward the wall. Hold for 30 seconds, and then switch legs.

Foam Roll:

Begin with the roller on the achilles and perform circular motions with your foot, 3x each direction. Then slowly move up the calf by progressing 2" up, 1" back, so you are doubling over. Stop to perform the foot circles on any sore spots.

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