Understanding, treating, and preventing this persistent heel pain

Achilles tendinitis is one of the most frustrating injuries we see at our clinic, particularly among runners, athletes, and active individuals. This condition affects the thick band of tissue that connects your calf muscles to your heel bone, and while it might start as a minor morning stiffness, it can quickly develop into a debilitating condition that sidelines you from your favourite activities.

What Exactly Is Achilles Tendinitis?

The Achilles tendon is the largest and strongest tendon in your body, capable of withstanding forces up to eight times your body weight during activities like running and jumping. Achilles tendinitis occurs when this tendon becomes inflamed, irritated, or develops small tears due to overuse, sudden increases in activity, or biomechanical issues.

There are two main types of Achilles tendinitis:

Insertional Achilles Tendinitis affects the lower portion of the tendon where it attaches to the heel bone. This type often involves bone spurs and can affect anyone, regardless of activity level.

Non-insertional Achilles Tendinitis affects the middle portion of the tendon and is more common in younger, active individuals. The tendon fibers in this area begin to break down, swell, and thicken.

Recognising the Warning Signs

Achilles tendinitis doesn't usually appear overnight. It typically develops gradually, with symptoms that may include:

• Morning stiffness and pain along the back of your leg near your heel, particularly noticeable when taking your first steps out of bed

• Mild aching after exercise or physical activity that may worsen over time

• Tenderness or stiffness that improves with mild activity but worsens with intense exercise

• Swelling along the tendon that persists throughout the day

• Thickening of the tendon that you can feel when pinching the area

• Pain that worsens when climbing stairs or hills

The hallmark sign that differentiates Achilles tendinitis from other conditions is the characteristic morning stiffness that improves slightly with gentle movement but returns after periods of rest.

What Causes Achilles Tendinitis?

Understanding the root cause of your Achilles tendinitis is crucial for effective treatment and prevention. The most common contributing factors include:

Training Errors: Sudden increases in training intensity, duration, or frequency without adequate progression can overload the tendon. This is particularly common when runners increase their weekly mileage too quickly or add hill running without proper preparation.

Biomechanical Issues: Poor foot mechanics, such as overpronation (when your foot rolls inward excessively), can place additional stress on the Achilles tendon. Similarly, tight calf muscles or weakness in the posterior chain can contribute to the problem.

Age-Related Changes: As we age, our tendons become less flexible and more prone to injury. The blood supply to the Achilles tendon also decreases with age, making healing more challenging.

Footwear Problems: Worn-out shoes that no longer provide adequate support, or switching to shoes with a different heel drop, can alter your gait and stress the tendon.

Medical Conditions: Certain conditions like rheumatoid arthritis, diabetes, and high blood pressure can increase your risk of developing tendinitis. Some antibiotics (fluoroquinolones) have also been linked to tendon problems.

The Treatment Approach: What Actually Works

At our clinic, we've found that successful treatment of Achilles tendinitis requires a comprehensive approach that addresses both the symptoms and underlying causes. Here's what the evidence shows works best:

Immediate Pain Management: In the acute phase, we focus on reducing inflammation and pain. This may involve activity modification (not complete rest), ice therapy, and sometimes anti-inflammatory medications as recommended by your GP.

Progressive Loading Program: Contrary to popular belief, complete rest rarely solves Achilles tendinitis. Instead, we design a progressive loading program that gradually reintroduces stress to the tendon in a controlled manner. Eccentric exercises, where you slowly lower your heel below the level of your toes, have shown particular promise in clinical studies.

Manual Therapy: Hands-on techniques can help improve blood flow, reduce muscle tension in the calf complex, and restore normal movement patterns. This might include soft tissue massage, joint mobilisation, and techniques to address restrictions in the ankle joint.

Biomechanical Assessment: We analyse your movement patterns, walking gait, and running technique to identify contributing factors. This often reveals issues with hip stability, ankle mobility, or foot mechanics that need addressing.

Strengthening Program: A targeted strengthening program focusing on the calf muscles, intrinsic foot muscles, and posterior chain helps build resilience in the tendon and surrounding structures.

Prevention: Your Best Defence

Preventing Achilles tendinitis is far easier than treating it. Our top prevention strategies include:

Smart Training Progression: Follow the 10% rule - never increase your training load by more than 10% from week to week. This applies to distance, intensity, and frequency.

Proper Warm-up and Cool-down: Always include dynamic stretching before activity and static stretching afterward, paying particular attention to your calf muscles.

Strength Training: Regular strengthening exercises for your calves, particularly eccentric exercises, can help prevent problems before they start.

Listen to Your Body: Early morning stiffness in your Achilles tendon is an early warning sign. Don't ignore it - address it promptly with gentle stretching and potentially a temporary reduction in training intensity.

Footwear Management: Replace running shoes every 300-500 miles and ensure any changes in footwear are made gradually.

When to Seek Professional Help

While mild Achilles discomfort might resolve with rest and gentle stretching, you should seek professional help if:

• Pain persists for more than a few days despite rest and self-care

• You experience severe pain or sudden onset of symptoms

• You notice visible swelling or thickening of the tendon

• Morning stiffness lasts more than 30 minutes

• Pain interferes with daily activities or sleep

Early intervention significantly improves outcomes and reduces the risk of the condition becoming chronic.

The Road to Recovery

Recovery from Achilles tendinitis requires patience. While some people may see improvement within a few weeks, others may require several months of consistent treatment. The key is adherence to your rehabilitation program and gradual return to activities.

Most patients we treat return to their full activity level within 3-6 months, provided they follow their treatment plan and avoid the temptation to return too quickly to high-impact activities.

Moving Forward

Achilles tendinitis can be a challenging condition, but with the right approach, most people make a complete recovery. The combination of appropriate load management, targeted exercises, and addressing underlying biomechanical issues provides the best outcomes.

If you're experiencing Achilles pain, don't let it become a chronic problem. Early assessment and treatment can get you back to the activities you love more quickly and help prevent future recurrence.

Remember, every case of Achilles tendinitis is unique, and what works for one person may not work for another. This is why individualised assessment and treatment planning is so important for successful outcomes.

Have you been struggling with Achilles pain? Our experienced physiotherapy team specialises in treating tendon injuries and can help develop a personalised recovery plan for you. Contact us today to book your assessment and take the first step toward getting back to pain-free movement.

Next in our series: Stay tuned for Part 3, where we'll explore another common injury and provide practical insights for prevention and treatment.