Achilles Tendon Pain Treatment in Melbourne

1 of 8 · Symptoms

Symptoms of Achilles Tendon Injuries

Achilles tendinopathy has a recognisable rhythm. Stiff and sore for the first steps of the morning, easing once you are moving, warming up during the early part of a run, then aching afterwards or the following day.

Symptoms lag the activity that caused them, so how the tendon feels in the twenty four hours after training tells you more than how it feels during it.

• Stiffness and pain for the first steps of the morning
• Pain at the start of a session that warms up
• Pain returning after training or the next morning, rather than during
• Tenderness when the tendon is pinched, sometimes with local swelling
• Thickening or a nodular feel in longstanding cases
• Loss of spring and power off that leg
• Insertional pain at the back of the heel, worse in flat shoes

2 of 8 · Other causes

What else could be causing the pain?

Pain around the Achilles is not always a tendinopathy. These are the other conditions our podiatrists will screen for on the day of your appointment.

• Achilles tendon tear
• Achilles paratenonitis
• Kager's fat pad swelling
• Retrocalcaneal bursitis
• Sural nerve entrapment
• Tibialis posterior tendinopathy

3 of 8 · Causes

What Causes Achilles Tendon Pain

Achilles tendinopathy is a mismatch between the load asked of the tendon and the capacity it has built. The tendon adapts more slowly than your fitness improves, and that gap is where most cases appear.

Complete rest is not the answer. Tendon tissue responds to load, and prolonged unloading lets capacity fall further. A short period of reduced loading is a step in a plan, not the plan itself.

1. 01A rapid increase in running volume, intensity, hills or speed work
2. 02Returning to training after time off at your previous volume
3. 03A change to lower heeled shoes, or a new surface
4. 04Reduced calf strength and endurance relative to your training demands
5. 05Limited ankle dorsiflexion or restricted first toe movement
6. 06Repeated stop start loading in court and field sports
7. 07Insertional cases: compression of the tendon against the heel bone

4 of 8 · Assessment

Assessment & Diagnosis

The first appointment has three aims: confirm the achilles is the pain source, establish whether it is mid portion or insertional, and understand why the tendon became overloaded.

Imaging is not required for diagnosis. Ultrasound and MRI often show tendon changes in people with no pain, so a scan can mislead if used as the starting point. We refer when a rupture or tear is suspected, or when a good program has not produced the expected change.

Dr Steven Singh, Principal Podiatrist

01

History

When the pain started, whether it built gradually or arrived suddenly, how it behaves in the morning and in the twenty four hours after a session, plus medication and previous injury.

02

Load and footwear

Weekly volume, recent increases, hills, speed work and surfaces, then running and everyday shoes, with attention to heel drop, heel counter shape and midsole life.

03

Physical examination

Locating the tender segment, assessing thickness, screening the retrocalcaneal bursa and calf, ankle range with the knee straight and bent, and calf raise endurance to fatigue.

04

Gait and running

How the tendon is actually loaded: contact pattern, how far the ankle bends, cadence, stride and push off symmetry, compared side to side.

5 of 8 · Treatment

Treatment & Recovery Process

Progressive loading is the core of achilles rehabilitation and everything else supports it. The aim is enough stimulus to adapt without tipping the tendon into a flare, then raising that stimulus as capacity improves.

We start by settling the tendon rather than stopping everything: trimming volume, dropping hills and speed work for a period, or swapping some running for cycling while loading continues in the gym.

1. 01Isometric calf holds early for pain relief and load tolerance
2. 02Slow, heavy calf raises with straight and bent knee
3. 03Spring like loading such as hopping and bounding once strength allows
4. 04Staged return to running built alongside the strength program
5. 05Reassessment or referral if the tendon is not responding as expected

6 of 8 · Recovery

What treatment involves and how long it takes

Tendons adapt slowly, so recovery may take weeks or months, and the sooner rehab starts, the sooner you return to sport. The most common cause of a stalled recovery is a program abandoned when it was on track.

1. 1

   Your first visit

   History, load and footwear review, examination and gait assessment, then a diagnosis of mid portion or insertional pain, a starting loading program, and immediate comfort measures.

2. 2

   One to four weeks

   The settling and building phase. Some discomfort during loading is acceptable if the tendon settles within twenty four hours and morning stiffness is not worsening.

3. 3

   Four weeks to three months

   Heavier and faster loading comes in, and running is rebuilt in stages, easy volume first and speed work last. Flares usually mean the load moved slightly ahead of capacity.

4. 4

   Return to full sport

   Often you can return within six to eight weeks, longer for longstanding cases. Keep the strength work going past the point where pain settles, at your own intensity and level of activity.

7 of 8 · Prevention

Prevention & Long-Term Management

The achilles is protected by two things: sensible progression of load, and a calf that is strong and does not fatigue early. Most recurrences happen when the strength work stops as soon as the pain does.

Morning stiffness is your early warning system. Stiffness getting longer week on week means the load is ahead of capacity, and that is the point to adjust rather than push on.

1. 01Progress volume and intensity gradually, changing one variable at a time
2. 02Rebuild after a break rather than resuming your previous volume
3. 03Keep calf strengthening year round, with straight and bent knee work
4. 04Include spring like loading such as skipping or hopping if you run

8 of 8 · Heel bursitis and insertional Achilles pain

Heel bursitis and insertional Achilles pain

Pain at the very back of the heel is not always the tendon. The retrocalcaneal bursa is a small fluid filled sac between the achilles and the heel bone, and repeated compression can leave it irritated and swollen.

Bursitis and insertional achilles tendinopathy often occur together, because the same mechanism drives both. Bursitis feels more diffuse and is often sore when squeezed from side to side.

• The bursa sits between the achilles tendon and the heel bone
• Bursitis and insertional achilles pain often occur together
• Compression at end range ankle dorsiflexion is the shared driver
• A soft, puffy swelling either side of the tendon is typical
• A prominent bony ridge or hard heel counter can aggravate it
• Management reduces compression while loading continues in a tolerated range
• Referral for imaging if swelling is significant or not settling