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This tendon is placed under significant load during sports involving repeated impact work, especially jumping movements. However, many non-sports men and women can also develop an Achilles tendinopathy due to repetitive activities.
The main feature on examination is often pain and thickening of the Achilles tendon when palpated.
X-rays and scans are not routinely required.
You may experience some pain and swelling at the back of the heal. This might feel as an area which is thick and lumpy behind your heal. The pain associated with Achilles tendinitis typically begins as a mild ache in the back of the leg or above the heel after running or other sports activity. Episodes of more severe pain may occur after prolonged running, stair climbing or sprinting, including prolonged standing. Often the most severe symptoms will be felt not at the time of these activities but the following morning when the Achilles tendon has developed stiffness overnight.
It is possible for the Achilles tendon to rupture as a sudden event. You may have felt a sudden sharp pain and/or heard a snap at the time of injury. In this case, you would be unable to stand on tiptoe, would walk with a flat foot and will notice severe swelling and bruising in the Achilles region. In this case, you should see your doctor as soon as possible, as early referral onwards usually results in better outcomes.
An Achilles tendinopathy can be managed effectively by adhering to the following advice and exercise routine. It is worth bearing in mind that recovery can take several weeks.
Immediate management is aimed at reducing swelling and alleviating pain to allow rehabilitation to commence as early as possible following injury.
Physiotherapy. The key treatment is physiotherapy, which involves stretching exercises of the tendo Achilles. Specific stretching and strengthening exercises to promote healing and strengthening of the Achilles tendon and its supporting structures.
A special type of strengthening called "eccentric" strengthening, involving a slow let down of a weight after raising it, has been found to be especially helpful for persistent Achilles problems.
Heel pad - A shoe insert or wedge that slightly elevates your heel can relieve strain on the tendon and provide a cushion that lessens the amount of force exerted on your Achilles tendon.
Medication - Painkillers as when required is advised.
Modifying aggravating activities. The Achilles tendon may need 4-6 weeks of relative rest initially to settle symptoms while you work on strengthening the calf muscles and Achilles tendon (see below).
Exercises. Regular exercises to strengthen and stretch the calf muscles and Achilles tendon.
If you are at all concerned about whether these exercises are suitable for you or if you experience any pain while doing them, please seek appropriate clinical advice from your GP or Physiotherapist.
Footwear. You should ensure that you use well-fitting, supportive footwear with adequate arch support, both during your everyday activities and, particularly, during exercise. Very flat shoes and high heels can also exacerbate the problem. Orthotic inserts placed inside your shoes can further reduce the load placed on the Achilles tendon.
Shockwave therapy. This may be offered as a treatment option for individuals with persistent pain in spite of undergoing a full course of physiotherapy.
Surgery is carried out as a daycase under anaesthesia. You will walk with some surgical shoes for 2 weeks and you will be invited to attend a follow-up appointment.
In very rare occasions you may have chronic pain as a result of surgery (CRPS), loss of limb and anaesthetic risk. However, these risks are very rare. Please discuss this further with your surgeon.
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