Achilles Tendinopathy - Self-Care

What you should know

Achilles Tendinopathy is typically an overuse injury. It can cause your Achilles tendon (the tendon which attaches your calf muscles to your heel bone) to become painful and sometimes cause a small lump to form in the tendon.

Tiny micro tears can appear in the tendon and, as a result of these repeated micro tears, Achilles Tendinopathy can occur. Tendinopathy, to be simplified is the inflammation of a tendon.

The Achilles tendon plays an important role in walking and running.

You are more likely to develop Achilles Tendinopathy if you;

  • Begin a new sport or hobby that requires high load of the tendon, (i.e. running and jumping)
  • Suddenly increase how much you are training in sports that require lots of running and jumping
  • Are over the age of 30
  • Have diabetes (type 1 or type 2)
  • Are a smoker
  • Are overweight
There is some evidence to suggest that middle aged males are at greater risk of suffering from this condition.
 

Symptoms

  • Pain just above your heel - most people find that their pain is on the Achilles tendon, which can be tender to touch or if gently squeezed. Occasionally there is a visible lump or swelling in the painful region.
  • Pain after activity - most people will notice that their pain increases after a long walk/run or at the end of the day, particularly when they ‘relax.’ Some people can exercise through the pain but notice as time goes on the pain increases during activity and can prevent them from doing their normal exercise or sport.
  • Morning stiffness - frequently people complain of stiffness around the Achilles in the morning, which usually eases after a few minutes of walking, but can take longer.

What to do

Do not be fearful of your pain, it doesn’t mean it is causing harm. Although pain isn’t causing harm, it may weaken your muscles over time. Therefore accept some discomfort, for example, an increase in your baseline pain to 2-3/10 that settles quickly (0 = your baseline/no pain, 10 = severe pain).

However, adapt, or limit the activity or exercise if it is making your baseline symptoms worse than 4/10, or if the symptoms last for a long time after you stop the activity or exercise. Initially it may be necessary to rest from aggravating activities, but not to stop all activities.

A gentle and gradual return is best where you build up slowly over time.

Pain medication


It may surprise you, but simple over the counter painkillers such as paracetamol and ibuprofen are the most effective pain medication. If you feel you need them – use them, following advice of a pharmacist. You should only take the recommended daily dose but do not wait until your pain is out of control to take them.

Consult with your GP/Pharmacist if you have any concerns and do not take ibuprofen or aspirin if you are pregnant, have asthma, an ulcer or indigestion.

Cold

 

An ice pack can be used to help reduce Achilles pain. Only use for 10-15 minutes on protected skin.

When using an ice pack you should make sure there is something between your skin and the source of heat/cold such as a paper towel or tea-towel.

Sleep


Sleep is really important when it comes to managing pain. Studies suggest that getting a good night’s sleep can reduce pain levels by as much as 25%.
 
Tips to improve your sleep include;
  • Sleep in a dark, quiet and cool room
  • Try taking your pain relief an hour before you go to bed
  • Do not consume caffeine within 6 hours of sleeping
  • Try to avoid eating within 2 hours of sleeping
  • Try to not be in front of bright screens such as TVs, laptops and phones for 1 hour before bed
  • Keep your bedroom as a place to sleep do not use it for work or as an office
  • If you do wake in the night and cannot get back to sleep, get up, go to another room and do something until you are tired before going back to sleep

Diet and nutrition


There are no special diets that have been shown to either help or prevent Achilles Tendinopathy. However, if you’re overweight you should consider changing your diet and doing some regular exercise to help you lose weight, as this is very likely to decrease your pain.

What’s recommend for us all is a well-balanced and healthy diet, which is low in saturated fats, sugar and salt. It’s also a very good idea to eat plenty of fresh fruit and vegetables, and to drink plenty of water.

If you need to lose weight, the key is to regularly burn off more energy than you consume on a daily basis.
 

Relaxtion


Stress can make pain worse. One way of reducing the effects of stress is to learn how to relax.

There are many relaxation, meditation or mindfulness tapes, CDs and MP3 downloads available – your doctor or physiotherapist may be able to offer you some, or they’re available online or from high-street shops. A good example is Headspace which is available online or as an application for your smart phone or tablet.

Exercises


If an exercise is painful to undertake or causes a moderate to high level of pain during or afterwards then reduce the difficulty level or stop that exercise.
  • Heel raise - stand up, push up on your toes and slowly lower. Repeat 10-30 times twice daily.
  • Seated heel raise - sit down with a weight on your right knee (as heavy as you can manage). Slowly bend your ankles so you come up on your toes then the return to start position with feet flat on floor. Repeat 10 – 15 times and aim for 3 sets.
  • Isometric holds on a step - stand on a step with both heels over the edge so there is some tension on your calf muscle. Hold on to a support and let the weight of your body stretch your heels towards the floor. Hold for 30-45 seconds and repeat 3 times. You can also repeat this with knees slightly bent.
  • Isometric holds with a band - sit on the floor or on a chair and put a towel or resistance band around your foot. Point your toes towards the floor but do not let your foot move. Hold for 30 - 45 seconds, relax and repeat 10 times.

 

When to see your GP/Physiotherapist

  • If your pain is no better after at least a month or you develop other symptoms
  • If the foot is hot, red and swollen
  • If you are being feverish and shortness of breath or if you have had a sudden unexplained loss of weight

Further resources

 

Authors: Cianan O’Sullivan, Noel Harding, Jane Leah, Cianán O’Sullivan, Jemima Cope and Catrin Astbury
Review Date: July 2022