Achilles tendinopathy is inflammation of the Achilles tendon, the tough band of tissue connecting the calf muscles to the heel.
Symptoms include pain in the back of the heel that worsens with activity.
Doctors usually make the diagnosis on the basis of symptoms and a physical examination, but sometimes, imaging (ultrasound or magnetic resonance imaging) is needed.
Ice and nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain and inflammation.
Resistance exercise and orthoses may prevent future injury.
Achilles tendinopathy is very common in runners. During running, the calf muscles help with the lift-off phase of gait (raising up on the toes from the foot being flat on the ground). Repetitive forces from running combined with insufficient recovery time from exercise can inflame the Achilles tendon. Use of antibiotics called fluoroquinolones increases the risk of Achilles tendinopathy and rupture of the tendon especially in people over age 60 years.
Pain in the lower calf and back of the heel is usually the first symptom of tendinopathy. Pain initially increases when exercise is begun and often lessens as exercise continues. Doctors diagnose Achilles tendinopathy based on the symptoms and results of an examination.
Ice and nonsteroidal anti-inflammatory drugs (NSAIDs) relieve pain and inflammation. Refraining from running and from pedaling a bicycle as long as the pain persists is important. Exercises to stretch and strengthen the hamstring muscles can be started as soon as they can be done without pain.
Other measures depend on what conditions are causing tendinopathy. Measures may include wearing shoes with flexible soles or placing heel lifts in running shoes to reduce tension on the tendon and stabilize the heel. People should return to running gradually, stretch the tendon before running, and, at the beginning, apply ice after running.
A complete tear of the Achilles tendon can occur with a sudden forceful change in direction, such as can occur when running or playing tennis. Sometimes people feel as if they have been kicked behind the ankle, and they sometimes hear a pop. The calf is very painful and walking is difficult, particularly when the tear is complete. The calf may be swollen and bruised. Splinting and sometimes surgery are required.
1. Sit in chair.
2. Bend knee on involved side to place top of involved foot on the floor with toes pointing backwards.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand facing or next to wall with hands on the wall.
2. Bend knee on involved side to place top of involved foot on
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand facing or next to wall with hands on the wall for support.
2. Place uninvolved leg forward.
3. Keep rear leg s
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand facing or next to wall with hands on the wall for support.
2. Place uninvolved leg forward.
3. Keep heels on t
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand on balls of feet with heels off the floor.
2. Walk on balls of feet while keeping knees straight.
3. Walk as f
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand on heels with balls of feet off the floor.
2. Walk on heels while keeping knees straight.
3. Walk as far as ab
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand with both feet on step with heels off edge of step. Hold on to something for support.
2. Raise up on balls of
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Sit in chair.
2. Bend knee on involved side to place top of involved foot on the floor with toes pointing backwards.
3. Slowly sit forward in the chair and push foot down until a stretch is felt over the top of the foot and ankle.
4. Hold stretch for 30 seconds.
5. Do 1 set of 4 repetitions, 3 times a day.
6. Special instructions
a. Do plantar flexion stretching while either sitting or standing, whichever is most comfortable.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand facing or next to wall with hands on the wall.
2. Bend knee on involved side to place top of involved foot on the floor with toes pointing backwards.
3. Bend knee on uninvolved side and slowly lower body until stretch is felt over the top of the foot and ankle.
4. Hold stretch for 30 seconds.
5. Do 1 set of 4 repetitions, 3 times a day.
6. Special instructions
a. Do plantar flexion stretching while either sitting or standing, whichever is most comfortable.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand facing or next to wall with hands on the wall for support.
2. Place uninvolved leg forward.
3. Keep rear leg straight with knees and toes pointing toward the wall, keep rear heel on the floor.
4. Bend knee on uninvolved leg and lean hips toward the wall to feel a stretch along the calf of the rear leg.
5. Hold stretch for 30 seconds.
6. Do 1 set of 4 repetitions, 3 times a day.
(It is important to maintain a straight back posture with the heel firmly planted [not lifted] during the stretch.)
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand facing or next to wall with hands on the wall for support.
2. Place uninvolved leg forward.
3. Keep heels on the floor and slowly bend both knees to feel stretch along the calf of the rear leg.
4. Hold stretch for 30 seconds.
5. Do 1 set of 4 repetitions, 3 times a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand on balls of feet with heels off the floor.
2. Walk on balls of feet while keeping knees straight.
3. Walk as far as able during given time frame, stop at point of fatigue.
4. Do 3 sets of 1 minute, 1 time a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand on heels with balls of feet off the floor.
2. Walk on heels while keeping knees straight.
3. Walk as far as able during given time frame, stop at point of fatigue.
4. Do 3 sets of 1 minute, 1 time a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
1. Stand with both feet on step with heels off edge of step. Hold on to something for support.
2. Raise up on balls of feet.
3. Focus on slowly lowering heels to below the height of the step.
4. Return to starting position and repeat.
5. Do 3 sets of 10 repetitions, 1 time a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
