Treating a Different Kind of Achilles Tendon Pain

Calf stretching, ice and activity modification are commonly used as treatment for those who suffer from Achilles tendinosis. However, when traditional treatment fails to relieve symptoms, the problem may be in the diagnosis.

Achilles tendon pain localized in the heel (known as insertional Achilles tendinopathy), can benefit from different treatment than when Achilles pain is present in the mid-portion of the Achilles tendon (known as intertendendinous Achilles tendinopathy). Mid-portion Achilles tendinopathy is primarily a tensile loading problem involving the ability of the Achilles to resist stretching, while insertional Achilles tendinopathy is a compression issue. When the ankle is loaded, which occurs when placing full weight on the foot during walking, the Achilles tendon is stretched and becomes compressed against its attachment site on the heel. This flat foot loaded position, placing the ankle in a position of maximal dorsiflexion, is also the position for stretching the calf. It is easy to understand why calf stretching would only compress the tendon and exacerbate the condition further. Therefore the best treatment includes avoiding stretching the Achilles. Other helpful treatment strategies include:

• Discontinue running, especially if symptoms are provoked for more than three hours following a run
• Avoid running uphill or extensive stair climbing
• Avoid wearing minimalist running shoes, flat shoes such as flip-flops or walking barefoot
• Use a heel lift in shoes, wear shoes with a heel (wide sole tennis shoe or wedge < 2″), or tape the Achilles or ankle to avoid excessive stretch on the Achilles
• Use ice as needed to manage symptoms
• Strengthen the calf in a protected position

Once the symptoms have resolved during general walking and stairs, calf strengthening can be initiated. Begin with calf raises in a shorted position (small book placed under heel) and progress to single leg calf raises from the floor. Avoid calf raises incorporating a heel drop off the edge of a step. Instead work to develop the amount of load the tendon can withstand by adding weight using a weighted backpack or weight vest. Pain should always be a guide with avoidance of soreness for greater than 2-3 hours following exercise.

It is important to note that these guidelines provide a basic recommendation for treatment and all conditions are unique, so always seek a comprehensive examination should self-management fail to resolve the symptoms. The entire lower extremity often contributes to the cause of the pain and the tendinopathy may return if the source of the problem is not properly addressed. Therefore, a free assessment by an experienced physical therapist at Athletico Physical Therapy can help you target the source of the problem and get you back on your feet and running.

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The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.

Resources:

Treating Insertional Achilles Pain: Why We’ve Been Doing It All Wrong. https://www.physiospot.com/opinion/treating-insertional-achilles-pain-why-weve-been-doing-it-all-wrong/. Published April 10, 2018. Accessed April 28, 2018.

Insertional Achilles Tendinopathy. http://www.running-physio.com/insertional-achilles-tendinopathy/. Published July 4, 2013. Accessed May 23, 25, 29, 2018.

Eccentric Loading Compared with Shock Wave Treatment for Chronic Insertional Achilles Tendinopathy. A Randomized, Controlled Trial. Rompe JD, Furia J, Maffulli N. J Bone Joint Surg Am. 2008;90:52-61. doi:10.2106/JBJS.F.01494

Sussmilch-Leitch SP, Collins NJ, Bialocerkowski AE, Warden SJ, Crossley KM. Physical therapies for Achilles tendinopathy: systematic review and meta-analysis. Journal of Foot and Ankle Research. 2012;5:15. doi:10.1186/1757-1146-5-15.

Treating Insertional Achilles Pain, Main Reason You Aren’t Getting Stronger, Random Thoughts. https://shari-berman.com/treating-insertional-achilles-pain-main-reason-you-arent-getting-stronger-random-thoughts/. Published May 6, 2018. Accessed May 9, May 17, 2018.