achilles tendinopathy

January 12, 2014

Jessica asked The Guru for the following Physiotherapy Advice:

Dear Guru, I have had a painful left achilles tendon for nearly 3 years. Originally, the tendon was swollen, tender and difficult to walk on. I had physiotherapy which seemed to ease it but not get rid of it completely. I was then referred to a podiatrist who gave me orthotics for my shoes and advised me to buy new trainers. Within two weeks of the new regime, my ankle was worse and my right ankle, which had had no problems until then, started hurting and being swollen like the left one. I threw away the orthotics and decided to try flatter shoes instead. For several months, these seemed to help the situation and I was even able to run for a couple of minutes at a time without my ankle becoming inflamed.

However, the symptoms never went away completely. Now, my ankle worsens if I wear shoes that don’t hold tightly onto my foot, and is stiff and painful in the mornings, especially if I sleep with my achilles tendon shortened (toes pointed). I avoid wearing heels. I have seen a personal trainer at the gym who says that there is a lot of scar tissue in both my calves, mainly around soleus, rather that gastrocnemius. I have also noticed that there appears to be a bony swelling at the base of my left tendon, but not my right. I recently saw an osteopath for back problems and he lengthened my left leg noticeably (!) Now my ankles are both complaining again, and my left ankle hurts just walking quickly. The tendon itself is no longer painful to touch. I don’t know what to do next and I am really fed up with this. Is there anything that will help? Thank you, Jessica

January 12, 2014

Hi Jessica

Cor! It sounds as if you’ve been through it. There are a few things that hint at what you need to do get on with next.

When you mention ankle I take it you mean Achilles and no the joint itself?

Having a 3 year problem will most likely mean that you’ve got a degenerate type tendon (don’t get put off by the words, it’s not going to degenerate away!) but it does mean that it sets up certain processes.

The orthotics that you were given were not helping, but the right orthotic can help. I think it’s why you need to have your shoe on tightly. Orthotics come in many different shapes and materials and prescriptions. You most likely need to have control of the way your foot rolls in. Letting your Achilles shorten at night and and then getting up and walking will super stretch your Achilles and force your foot to roll in….

You need to therefore take the excessive load out out your Achilles by increasing the length of your calf muscles (by getting them released but NOT stretching them) and controlling the amount of foot rolling in (pronation). You will also need a controlled and progressive eccentric loading program for you Achilles.

Because of the chronicity you will undoubtedly have issue with the way you use and recruit lots of different muscles from your pelvis down. This is super important to understand and deal with.

I wouldn’t let anyone touch, massage, rub of stretch your Achilles (yet!).

You’ll need to work on this, and it must be the right type of input for at least a 10 week program to feel and significant change.

Let me know if this doesn’t make sense……..

The Guru

Guru Responded

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