INJURY
Achilles pain starts as heel stiffness, but can become debilitating
THE ACHILLES – the tendon that attaches the gastrocnemius and soleus muscles (known together as the calf muscles) to the calcaneus (heel bone) – is such a common area for runners to injure that only the knee can knock it off the top of the injury leader board. Pain is noticed more as Achilles stiffness initially, first thing in the morning. It’s only when the pain starts to influence their running do they present to clinic in search of some answers.
Common reasons for injury
Why the Achilles is such a common site for injury is largely unknown despite several internet articles suggesting that it’s down to poorly fitting shoes, bad running technique or, my personal bugbear, overpronation. The fact is that we just don’t know what the main cause is. What we do know is that the tendon itself breaks down. When it becomes injured it affects the collagen fibres that make up the tendon and this causes stiffness and pain. The fibres have a short-lived period of inflammation and then what’s left is a sort of inflammatory soup that causes disruption to the fibres, which creates the common bump seen on the distal third of the tendon.
During the acute phase (although these injuries are chronic in nature there has to be a start point of injury which we refer to as acute or onset of injury), the additional fluid within the structure creates an opportunity for blood vessels to work their way into the tendon from the fat pad just anterior to the Achilles. Early-stage management of an Achilles tendon injury is the key to success. In patients who present on first signs of soreness, it is highly likely that just the outer layer, known as the paratendon, will be inflamed. The paratendon can become inflamed and irritated, causing similar symptoms to a full-blown Achilles tendinopathy.
The methods used to treat an Achilles have changed more times since I became a physiotherapist than the approach to any other injury. Research is always evolving in this area and there are a greater number of research papers currently, largely owing to the increased numbers of those suffering.