Achilles Tendinopathy

The development of Achilles tendinopathy is often multifactorial, resulting from a combination of factors. The primary cause is overuse or repetitive strain on the Achilles tendon, which can lead to micro-tears and degeneration over time.

Common contributing factors include:

• Overuse and Sudden Increases in Activity: Rapid escalation in the intensity or frequency of exercise without adequate rest can overload the tendon.
• Biomechanical Issues: Abnormal foot structures such as flat feet (overpronation) or high arches can increase stress on the Achilles tendon.
• Inadequate Footwear: Shoes that provide poor cushioning or lack proper support can exacerbate strain on the tendon.
• Tight or Weak Calf Muscles: Muscle imbalances can heighten the load placed on the Achilles tendon during physical activities.
• Aging and Degeneration: The tendon naturally loses elasticity and strength with age, making it more susceptible to injury.
• Obesity and Inactivity: Excess body weight increases the load on the tendon, while a sedentary lifestyle can contribute to muscle weakness and tendon stiffness.
• Medical Conditions: Conditions like diabetes, hypercholesterolemia, and rheumatoid arthritis may impair tendon health and contribute to tendinopathy.

Achilles tendinopathy typically presents with a range of symptoms that develop gradually. The most common symptoms include:

• Pain and Tenderness: Pain is usually felt at the back of the heel or along the tendon, particularly during or after physical activity. The pain may also be worse in the morning or after periods of rest.
• Stiffness: Morning stiffness or stiffness after prolonged inactivity is a hallmark symptom. The stiffness often improves with mild activity but can return after intense exercise.
• Swelling and Thickening: The tendon may appear swollen or thickened compared to the unaffected side.
• Decreased Strength and Function: The affected leg may feel weaker, and individuals may have difficulty performing activities that involve pushing off the foot, such as climbing stairs or sprinting.

Diagnosing Achilles tendinopathy involves a comprehensive assessment by a foot and ankle specialist. Dr. Allison Boden, M.D. has expertise in foot and ankle conditions and will ensure accurate diagnosis and tailored treatment plans for patients experiencing Achilles tendon issues.

The diagnostic process typically includes:

Medical History

Dr. Boden will gather information about the patient’s symptoms, physical activity levels, and any previous injuries or medical conditions.

Physical Examination

She will perform a thorough examination of the foot and ankle including the Achilles tendon to assess tenderness, swelling, and range of motion. She may gently palpate the tendon to identify pain or thickening.

Imaging Studies

In some cases, imaging studies are necessary to confirm the diagnosis and assess the extent of tendon damage.

• Ultrasound: This imaging technique provides a detailed view of the tendon, revealing areas of thickening, inflammation, or tears.
• MRI (Magnetic Resonance Imaging): MRI is often used to obtain high-resolution images of the Achilles tendon, particularly in cases where a tear or significant degeneration is suspected.
• X-rays: While X-rays do not show soft tissues like tendons, they can help rule out other conditions such as bone spurs or calcifications near the tendon. 

Early diagnosis and intervention are crucial in preventing Achilles tendinopathy from progressing to more severe stages. Prompt treatment can alleviate pain, restore function, and reduce the risk of long-term complications. Delayed treatment may lead to chronic tendon degeneration, making recovery more challenging.