Stokewood Injury Clinic

Achillies Tendonitis

It is estimated that Achilles tendonitis accounts for around 11% of all running injuries. The Achilles tendon is the large tendon at the back of the ankle. It connects the large calf muscles (Gastrocnemius and Soleus) to the heel bone (calcaneus) and provides the power in the push off phase of the gait cycle (walking and running).

Achilles tendonitis is often now being referred to as Achilles tendinopathy. This is because it is no longer thought to be an inflammatory condition. On investigation, the main finding is usually degenerated tissue with a loss of normal fibre structure.
Achilles tendonitis can be either acute, meaning occurring over a period of a few days, following an increase in training, or chronic which occurs over a longer period of time. In addition to being either chronic or acute, the condition can also be either at the attachment point to the heel or in the mid-portion of the tendon (typically around 4cm above the heel). Healing of the Achilles tendon is often slow, due to its poor blood supply.

Symptoms of Achilles Tendonitis
Acute tendonitis:

  •  
  • Gradual onset of pain over a period of days
  • Pain at the onset of exercise which fades as the exercise progresses.
  • Pain eases with rest.
  • Tenderness on palpation.
    • Chronic Achilles tendonitis may follow on from acute tendonitis if it goes untreated or is not allow sufficient rest. Chronic Achilles tendonitis is a difficult condition to treat, particularly in older athletes who appear to suffer more often.

      Chronic tendonitis:

      •  
      • Gradual onset of pain over a period of weeks, or even months.
      • Pain with all exercise, which is constant throughout.
      • Pain in the tendon when walking especially uphill or up stairs. Pain and stiffness in the Achilles tendon especially in the morning or after rest.
      • There may be nodules or lumps in the Achilles tendon, particularly 2-4cm above the heel.
      • Tenderness on palpation.
      • Swelling or thickening over the Achilles tendon.
      • There may be redness over the skin.
      • You can sometimes feel a creaking when you press your fingers into the tendon and move the ankle.
        • Causes of Achilles Tendonitis

          Achilles tendonitis is an overuse injury. Too much too soon is the basic cause of overuse injuries, however other factors can contribute to developing the condition.

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          • Increase in activity (either distance, speed or hills).
          • Less recovery time between activities.
          • Change of footwear or training surface.
          • Weak calf muscles.
          • Decreased range of motion at the ankle joint, usually cause by tight calf muscles.
          • Running up hills - the Achilles tendon has to stretch more than normal on every stride. This is fine for a while but will mean the tendon will fatigue sooner than normal.
          • Overpronation or feet which roll in when running can place an increased strain on the Achilles tendon. As the foot rolls in (flattens) the lower leg also rotates inwards which places twisting stresses on the tendon.
          • Wearing high heels constantly shortens the tendon and calf muscles. When exercising in flat running shoes, the tendon is stretched beyond its normal range which places an 'abnormal' strain on the tendon.

Feet Injuries

Plantar Fasciitis

Plantar Fasciitis is a painful condition caused by overuse of the plantar fascia or arch tendon of the foot. The Plantar Fascia is a broad, thick band of tissue that runs from under the heel to the front of the foot.

Plantar fasciitis can also be known as a heel spur (Policeman`s Foot) although they are not strictly the same. A heel spur is a bony growth that occurs at the attachment of the plantar fascia to the heel bone (calcaneus).

A heel spur can be present (through repetitive pulling of the plantar fascia) on a foot with no symptoms at all and a painful heel does not always have a heel spur present.

Plantar fasciitis is traditionally thought to be an inflammatory condition. This is now believed to be incorrect due to the absence of inflammatory cells within the fascia. The cause of pain and dysfunction is now thought to be degeneration of the collagen fibres close to the attachment to the calcaneus (heel bone).

What are the Signs and Symptoms?

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  • Heel pain, under the heel and usually on the inside, at the origin of the attachment of the fascia.
  • Pain when pressing on the inside of the heel and sometimes along the arch
  • Pain is usually worse first thing in the morning as the fascia tightens up overnight. After a few minutes it eases as the foot gets warmed up
  • As the condition becomes more severe the pain can get worse throughout the day if activity continues.
  • Stretching the plantar fascia may be painful.
  • Sometimes there may also be pain along the outside border of the heel. This may occur due to the offloading the painful side of the heel by walking on the outside border of the foot. It may also be associated with the high impact of landing on the outside of the heel if you have high arched feet.
    • Plantar fasciitis or heel spurs are common in sports which involve running, dancing or jumping.

      Runners who overpronate (feet rolling in or flattening) are particularly at risk as the biomechanics of the foot pronating causes additional stretching of the plantar fascia.

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