Achilles/calf pain

What is Achilles Pain?

The Achilles is a prominent tendon in back of your lower leg. This large tendon is an extension of the two calf muscles; it runs down the back of the lower leg and attaches to the heel bone (calcaneus). The Achilles tendon connects the strong leg muscles to the foot and gives us the ability to rise up on our toes, facilitating the act of walking. The Achilles tendon is vital to our ability to walk upright. As you can imagine, it is placed under tremendous stress and strain.

What is causing my pain?

Pain in this region could be due to any one of the following:

• Achilles tendonitis – acute inflammatory condition
• Achilles tendonosis – chronic and degenerative condition
• Para-tendonitis
• Partial tears
• Tendon rupture
• Retro-calcaneal bursitis
• Posterior impingement syndrome
• Sever’s disease – growth plate disorder
• Achilles bursitis
• Referred pain from knee, hip or spine

The most common conditions are the acute and chronic cases – referred to collectively as Achilles Tendonopathies.

Symptoms include pain which may be present at the achilles tendon during activity and may also increase once activity has been initiated after a period of rest. Tenderness can usually be felt along the course of the tendon and in some cases there may be the presence of a localized nodule (small sack of fluid) on the tendon.

Achilles Tendonopathy commonly occurs from shearing and tractional forces placed on the Achilles Tendon. The calf muscles assist inversion of the calcaneus at heel lift. When a condition occurs where the foot accelerates into an excessively pronated position and the calcaneus is everted, there’s an increase in medial tendo-achilles traction and this results in transverse shearing of the tendon and sheath – this commonly leads to inflammation and pain. Often, a lumpy build-up of scar tissue occurs.

Common causes of achilles pain include:

• The biggest contributing factor is ignoring the pain in the tendon.
• Achilles Pain commonly occurs from shearing and stretching forces placed on the achilles tendon. Excess Pronation (rolling over of the foot) causes extra strain on the tendon. Inflammation of the tendon is a common result along with tightening of the calf muscles.
• Sudden increases in training can lead to achilles tendonitis.
• Excessive hill running or speed work.
• Inappropriate shoes. If the soles of the shoes are too stiff, this causes the forefoot to have limited movement. This can lead to increased tension to the achilles tendon.
• Studies have shown that excessive heel cushioning can be a contributing factor. Air filled heels are not very good for achilles tendonitis. If you wear a shoe that is designed to give greater shock absorption, what frequently happens is when the heel makes contact with the ground and continues to sink lower while the shoe is absorbing the shock. This causes the achilles tendon to be stretched.
• Tight calve muscles.
• Mechanical abnormalities of the feet such as over pronation.
• Women who take up running are at a greater risk. This mainly affects women who wear high-heeled shoes, which effectively shorten the achilles tendon. When the individual then takes up running in “flat shoes”, the achilles tendon is put under increased tension.

What are the common methods used to treat Achilles pain?

Common methods of treatment used:

• Cut back on your training routine to reduce damage and allow repair.
• Reduce hill and speed running temporarily until Achilles gains strength.
• If there is a complete rupture of the achilles tendon then surgery will be necessary. Avoid excessively flat shoes and try not to walk bare foot too much if you suspect any level of tear – seek help from a health professional such as your doctor immediately.
• By preventing excess subtalar joint pronation with custom orthotics to reduce medial tendo-achilles traction, therefore helping to alleviate the problem.
• Eccentric muscle loading – contracting the muscle while it lengthens – seek the advice of a health professional before you attempt this (risks involved).
• Ice therapy for acute conditions (15 minutes, 3 times a day), rest from running.
• Heat therapy for chronic conditions – encourage blood flow and healing.
• See your health professional if symptoms persist.

Can Auckland Sports Podiatry help?

Most likely, as your achilles can be strategically relieved of the damaging stress and strain responsible for your pain.

How is this achieved?

Through an accurate biomechanical examination to distinguish the duration, amount of contracture and tension. Once this knowledge is attained, a thorough treatment plan is introduced, with the intention of restoring full strength and preventing future damages. Not to mention improve your performance and reduce the likelihood of injury in other parts of your body – see Orthotic Therapy for a more detailed discussion of the positive effects of re-aligning your lower extremity.