The Achilles tendon is the strongest and thickest tendon in the body and attaches into the heel from the calf muscles (gastrocnemius and soleus). The lower third of the tendon is where the problem tends to occur. This is mostly due to the huge diagonal force placed on the tendon as the heel contacts the ground. This diagonal pull on the tendon known as ‘bowstringing’ can lead to microtears, scar tissue, or loss of tissue (collagen) which will cause pain on activity.
Overuse of the Achilles from sport (particularly running), excessive pronation, very tight calf muscles, poor range of motion of the ankle and footwear are all typical causes.
Treatment is always best started as early as possible because even with intense treatment, rest from aggravating activity, and early diagnosis, complete resolution will still take between three to six months.
Early treatment is best achieved through the RICE (rest, ice, compress and elevate) and other anti-inflammatory modalities, muscle strengthening programmes, and heel raises (in-shoe). Vigorous stretching exercises, correction of any abnormal biomechanics through insoles or orthotics and advice on footwear are important to prevent the problem worsening.