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The Injurance Blog pt3 - Achilles tendonitis and endurance athletes

In addition to our regular Endurance Blog, which covers topics related to endurance coaching and nutrition, we will also be publishing Injurance Blog, which cover common injury topics for endurance athletes.

We work in conjunction with A6 Physiotherapy and Axis Podiatry who contribute their expert advice for each blog post. If you have any questions, post them on THE ENDURANCE STORE Facebook Page, where this blog in posted.

Of all the issues we see in store, Achilles tendonitis is possibly the most common. This week Sam and Dr Lindsay give us the low down on how to treat and cure this common runner's injury:

Achilles tendinopathy is the correct term and is usually experienced as pain and swelling to the band of tissue (tendon) that runs down the back of your lower leg to your heel. The pain tends to come and go and usually is worse first thing in the morning or after exercise. Morning symptoms can include stiffness which eases with movement.

There are 2 sections of the achilles that can be affected. Mid-portion achilles tendinopathy affects the mid-section of the achilles (2-7cm above the calcaneus/heel bone). This is the soft part of the tendon joining your calf and your heel. It is likely to be swollen and is often painful to pinch the tendon.

Insertional tendinopathy is painful at the insertion site to the calcaneus/back of the heel bone. It is the point where the tendon attaches onto the heel bone.

Correct diagnosis is critical for treatment

Insertional tendinopathy will be aggravated by dorsiflexion (your heel dropping down). It is critical that you see a physio to correctly diagnose your injury. Doing 'heel drops' are a common way to treat mid-portion Achilles Tendonitis, but for Insertional tendinopathy, it is likely to increase compression and aggravate the symptoms. Likewise calf stretches would also aggravate symptoms for insertional tendinopathy.

How to treat Achilles Tendinopathy

Mid-portion achilles tendinopathy is thought to be easier to treat than insertional tendinopathy. The general treatment of the achilles is to reduce pain, build strength with the end goal of returning to sport. With achilles tendinopathy rehabilitation the initial aim is to reduce the pain with rest and isometric exercises with consideration of using anti-inflammatories. Once pain is under control loading exercises can be introduced.

Managing the load is crucial. In order to manage the load you need to understand what is causing the overload. Repetitive mechanical loading is thought to be a major causative factor of achilles tendinopathy. Activities such as running, jumping and impact are key. Start to make a mental note when you experience pain and what activity is the trigger. Give the pain a scale between 0-10 with 0 being no pain and 10 being the worst pain imaginable. If you are exercising and the pain is greater than 3 out of 10 then chances are you are overloading with this activity and you will need to stop.

Choose an alternative form of exercise short term. It is important to understand that insertional and mid-portion achilles tendinopathy do not follow the same recipe for rehabilitation. If you can understand insertional then it is easy to avoid the trap of aggravating the tendon and making it worse, rather than rehabilitating it.

Podiatry & gait ssessment

From a podiatrist's perspective, the lower limb, ankle and foot should be assessed by watching someone run from behind (as per treadmill gait analysis in a shop) which might highlight an alignment issue of the Achilles’ tendon. The Achilles can be bowing in or out depending on whether you are over pronating or supinating and crucially this is where a lot of issues are missed.

It's also important to assess the lower leg from the side. A lot of Achilles tendinopathies that haven’t responded to either previous treatment and even previous orthotic prescriptions are missing this 'side on' element. On many occasions the runner has a forefoot 'equinus' which means their forefoot anatomically sits lower than their rearfoot / heel. For these runners, zero or low drop shoes or even a sudden change in drop could be a disaster. I have as a podiatrist definitely seen an increase in achilles tendon injuries since the fairly recent trend in zero drop running shoes and even subtle changes in drop. For example the same make and model of shoe might now have 4mm less drop than it previously did. If it changes from 12mm to 8mm, this can be significant if the runner is unaware and hasn’t changed their running style.

We'd love to hear from you if you have suffered from hot foot during a running or triathlon event. Comment below this post on THE ENDURANCE STORE Facebook page and let us know your experiences and questions!

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