Inflammation, irritation and swelling of the Achilles tendon, which is attached to the gastrocnemius (calf muscle) at the attachment of the calcaneus (heel bone). The underlying cause of Achilles tendonitis is the result of aggravation caused by pronation and supination – or a combination of both. As the calcaneus inverts at the heel lift, the calf muscles assist and as the foot accelerates into an excessively pronated or supinated position, the calcaneus is everted or inverted causing medial/lateral tendo-achilles traction. This results in transverse shearing of the tendon and sheath, leading to inflammation and pain experienced. Also referred to Tenosinovitis & Tendonopathy.
Cause:
Pronation is a major contributing factor to medical Achilles pain. Lateral Achilles pain is associated with Pes Cavus (high arch) footstructure or forefoot valgus >10 degrees. A combination of supination and pronation causes medical and lateral swelling and pain. Unilateral Archilles pain can be also be associated with a structural or functional leg length discrepancy.
Symptoms:
Inflammation and swelling where the Achilles tendon attached to the calcaneus (heel bone). Pain can be experienced either on the medial (inside) or lateral (outside) aspects of the Achilles. In extreme cases the Achilles tendon can rupture and detach from the calcaneus, or a compensatory bone spur may develop to maintain control of the Achilles Tendon.
– Bilateral medial Achilles pain – check for pronation.
– Bilateral lateral Achilles pain – check for supination and a high forefoot valgus.
– Unilateral Achilles pain – assess for structural or functional leg length discrepancy.
Treatment:
– Orthotics moulded to STJ neutral to control pronation & supination.
– Temporary heel lift (2 weeks) applied to both left & right orthotics to relieve Achilles tendon.
– Deep tissue massage – DO NOT stretch the Achilles tendon whilst the sheath is inflamed.
– Anti-inflammatory medication.
