Ankle pain: Achilles

The Achilles tendon

Pain at the back of the ankle is commonly related to injury of the achilles tendon. The achilles is the tendon at the back of your ankle which attaches your calf muscle to your heel bone. Achilles pain is felt either lower down at the back of the heel bone where the tendon attaches, or halfway between the foot and the calf muscle.

Causes of Achilles pain

The most common cause of achilles tendon pain is usually achilles tendinopathy (also known as achilles tendinitis). Achilles pain due to a tendinopathy usually comes on gradually and worsens over time rather than suddenly. If there is sudden acute pain, then a tendon tear or rupture needs to be considered and ruled out.

Achilles pain is often present on starting to exercise but then can warm up and improve during activity. Pain can be worse the next morning when first standing up or walking, and then can continue to feel stiff and sore throughout the day. Achilles pain may become quite severe, walking can become increasingly difficult and local swelling may be present, particularly if left untreated.

This type of Achilles injury usually comes on due to an increase in load that the tendon is not able to adapt to. Some examples of this are: starting a new activity, adding more time or distance such as in running program or training for a long-distance walk, increased intensity of an activity such as starting a HIIT class or bootcamp, or a change in footwear or surface.

Achilles injury treatment and management

Management of achilles pain and injury involves hands-on Osteopathic treatment with us at Pivotal Osteopathy to improve range of motion in the ankle and foot and to reduce the muscle tightness in the calf and foot. We may also treat higher up around the knee/hip/pelvis depending on how these are moving. The cornerstone of recovery from Achilles tendinopathy is exercise rehabilitation.

The tendon must be slowly and gradually appropriately loaded in order to be able to adapt to an increased load. We usually approach this in two main ways. Firstly, by temporarily reducing the training load to allow the tendon to settle, heal and become less irritated; and secondly, by prescribing you specific exercises for your body and situation to help strengthen up the lower body, particularly the ankle and foot. We may also assess your running style and footwear to provide advice on small changes which may further improve your recovery. If you don’t play sport or exercise much but have Achilles pain, then the changes will relate to adjusting your day-to-day activities and footwear, in addition to exercise rehabilitation.

Achilles injuries do not tend to recover just with rest alone, and recovery does take some time and effort. Getting an accurate diagnosis, treatment and management plan specific to you is pivotal to a faster and improved recovery.