Achilles Tendonitis & Tendinopathy Treatment Sydney

Different Types of Achilles Tendon Injuries We Treat

Before we dive into achilles tendonitis treatment options, it’s important to identify what type of achilles injury you have. There are various terms used to label an achilles injury, such as; achilles tendonitis, achilles tendinosis, achilles tendinopathy and achilles paratenonitis. For clarity and highlighting how an accurate diagnosis is important for best treatment plans, a brief outline for each of these is below;

Achilles tendonitis

Achilles tendonitis refers to when the achilles tendon is acutely overloaded and inflamed. The ‘itis’ in tendonitis refers to inflammation. This sort of condition is often called a ‘reactive tendon’; the tendon swells and signals pain as a protective mechanism so you don’t create structural damage (as seen in tendinosis). This is an acute overload of the achilles tendon and it will feel uniformly thicker along the entire tendon (fusiform swelling) and more sensitive to squeeze than the non-symptomatic side. Symptoms are usually high grade and the tendon typically doesn’t ‘warm-up’ and improve as you exercise. Achilles tendonitis treatment is best implemented early with rest and offloading.

Achilles tendinosis

Achilles tendinosis refers to when the achilles tendon has been chronically overloaded over a period of months. The ‘osis’ in tendinosis refers to a change in tendon structure, often as focal areas of ‘scar tissue’ or less dense or aligned collagen fibres that make up the tendon structure, and thus this condition is often called a ‘degenerative tendon’. This can be seen on imaging and in some cases, you can feel lumps and bumps when running your fingers along the length of the achilles tendon. Symptoms are usually lower grade than achilles tendonitis and typically you will feel morning stiffness that eases off as your tendon warms up. Some people can function relatively well with an achilles tendinosis and can still participate in their sport but may need a little longer to warm up before higher intensity exercise for the tendon to feel pain free. Typically, the tendon will be sorer the next morning after more intense exercise. Achilles tendinosis treatment usually always involves heavy slow resistance training in the form of calf raise exercises.

Achilles tendinopathy

Achilles tendinopathy is an umbrella term that can encompass both tendinitis and tendinosis. It is also possible (and common) to have co-existing diagnoses; where someone has a degenerative tendon with low grade chronic symptoms, but they turn it into a reactive tendon and re-introduce higher grade symptoms and swelling after an increase in activity. This is also known as an ‘acute-on-chronic’ tendinopathy.

Achilles paratenonitis

As opposed to tendinitis and tendinosis, which are conditions of the tendon itself, achilles paratenonitis is an acute injury involving inflammation and swelling of the lining of the achilles tendon, also known as the tendon sheath. Typically, there will be high grade pain and significant swelling around the tendon, with a key difference to tendinitis being the presence of crepitus. Crepitus is a creaking or crunching like sensation that can be felt when pointing the foot up and down. The term achilles peritendinitis is also used interchangeably with paratneonitis to describe this condition.

We also need to consider other diagnoses around the achilles tendon, which include; insertional achilles tendinopathy, retrocalcaneal bursitis, subcutaneous calcaneal bursitis, Kager’s fat pad inflammation and plantaris-related achilles pain.

How We Treat Achilles Tendinitis

Treatment

Treatment will vary substantially depending on the diagnosis. By outlining all the possible diagnoses in and around the achilles tendon I hope to highlight the importance of a correct diagnosis to optimise treatment.

Possible treatments:

1. Load management advice – i.e. when its OK to exercise through pain vs none at all and how to modify activities to aid in recovery. This advice can vary significantly when dealing with an achilles tendinosis vs achilles tendinitis condition.
2. Reducing pain and improving function via footwear advice, taping and heel lifts. These are easy wins and can have an immediate positive effect on symptoms.
3. Foot orthotics; after assessing foot structure and function we’re able to get an idea on how likely foot function may be contributing to achilles pain and tailor treatment accordingly. Many people with achilles tendinopathy won’t benefit much from adding orthotics to management. However, there are some that get huge benefit, the key is to identify who is likely to be a “responder” to extra support via an orthotic. Often, we will trial strapping or prefabricated orthotics to make sure there’s a positive effect on pain and function before we suggest custom orthotics.
4. Gait retraining and running technique advice.
5. Rehab programs to address strength/flexibility deficits. For example; achilles tendinosis does well with graded exposure to high resistance exercises such as weighted calf raises.
6. Injection therapy such as high-volume saline injections or prolotherapy. These are best suited to those with achilles tendinosis.

To find out more, check out our achilles tendinosis treatment guide or book a consultation today. We also do telehealth sports podiatry in Sydney which can work quite well for many issues including achilles tendinopathy.