Achilles Tendinopathy Treatment Sydney

Achilles tendinopathy is a painful condition affecting the Achilles tendon, which attaches your calf muscles to your heel bone.

Our podiatrists at North Sydney Podiatry are equipped with extensive knowledge on Achilles tendinopathy treatment strategies and the range of non-surgical and surgical treatment options to treat this condition.

What is Achilles Tendinopathy?

Achilles tendinopathy is a common condition affecting the Achilles tendon, which connects your heel bone to your calf muscles. While a tendon injury may seem to happen suddenly, it is usually the result of many tiny tears in the tendon that have happened over time. While anyone can have a tendon injury, most cases are a result of the gradual wear and tear to the tendon from overuse or aging, making it a common injury among joggers and jumpers.

Achilles tendinopathy is graded according to severity:

Mild - pain in the Achilles tendon during a particular activity (e.g. running) or shortly after.
Moderate - the Achilles tendon may swell. In some cases, a hard lump (called a nodule) may form on the tendon.
Severe - any activity involving weight-bearing causes pain in the Achilles tendon. Very occasionally, the Achilles tendon may rupture.

Tendinopathy is an umbrella term that describes Achilles tendon disorders:

Achilles tendinitis - refers to the acute inflammation of the Achilles tendon, usually caused by overuse or injury, causing pain, tenderness and stiffness.
Achilles tendinosis - a chronic, non-inflammatory degradation of the tendon's collagen fibres, typically caused by chronic overuse or failed healing, causing persistent pain, stiffness and reduced strength.

There are 2 different types of Achilles tendinitis, depending on which part of the tendon is inflamed. These can occur separately or at the same time.

Insertional Achilles Tendinitis

Insertional Achilles tendinitis involves the lower portion of the tendon where it attaches to the heel bone. Damaged tendon fibres can calcify over time, and bone spurs often form on the back of the heel. This condition can affect anyone, even people who aren't active, but it most commonly affects people who overuse the tendon. Both insertional and non-insertional Achilles tendinitis can cause calcification of damaged tendon fibres.

Non-insertional Achilles Tendinitis

Noninsertional Achilles tendinitis involves the fibres in the middle portion of the tendon, above where it attaches to the heel. Over time, the fibres break down and develop tiny tears. This can lead to the swelling and thickening of the tendon. Noninsertional Achilles tendinitis more commonly affects younger, active people, especially runners.

Causes of Achilles Tendinopathy

Overuse - occurs when the Achilles tendon is stressed until it develops small tears and degeneration. Runners and people who play sports that involve jumping, such as basketball, are most susceptible.
Arthritis - Achilles tendinitis can be a part of generalised inflammatory arthritis, such as ankylosing spondylitis or psoriatic arthritis. In these conditions, both tendons can be affected.
Footwear - wearing shoes with minimal support while walking or running can increase the risk, as well as wearing high heels.
Foot problems - people with flat feet or abnormally pronated feet are prone to Achilles tendinitis. The flattened arch pulls on the calf muscles and keeps the Achilles tendon under tight strain. This constant mechanical stress on the heel and tendon can cause pain, inflammation and swelling of the tendon.
Obesity - being overweight places more strain on many parts of the body, including the Achilles tendon.
Cortisone injections - repetitive cortisone injections can weaken/damage the tendon, leading to Achilles tendon rupture.

Symptoms of Achilles Tendinopathy

Achilles tendon pain and stiffness in the morning
Pain along the tendon or back of the heel that worsens with activity
Swelling, tenderness and warmth of the Achilles tendon
Thickening of the tendon
Difficulty walking
Heel pain when you wear shoes

How Can A Podiatrist Help?

To properly diagnose Achilles tendinopathy, our podiatrists will perform a biomechanical assessment to identify contributing factors, such as tight calf muscles, foot structure, or gait issues. We discuss your medical history, including exercise levels and footwear, to understand how you are affected fully.

We develop personalised rehabilitation plans centred on interventions specific to your individual condition, focusing on your foot mechanics. Our Sydney podiatrists may also utilise/recommend additional interventions that align with your preferences, including but not limited to orthotics, shockwave therapy, and footwear modifications to reduce strain while the tendon heals and improve the tendon's capacity to handle weight and stress over time.

In some cases, you may be referred for imaging (MRI scan or ultrasound) to confirm your diagnosis and determine if there is any calcification of the tendon, or if another issue is present, such as Haglund's deformity. If conservative treatments are unsuccessful, surgical interventions may be necessary.

Treatment of Achilles Tendinopathy

These treatments aim to reduce strain on the tendon, prevent further injury and allow time for repair. Recovery is often slow and depends on the severity of your condition, how carefully you follow the treatment and care instructions you are given. Treatment is different for every individual, as one approach may not yield the same results for another.

Our Sydney podiatrists take into account your medical history, any injuries, activity level and preferences to create a tailored, progressive loading plan to strengthen and improve the tendon's capacity and reduce pain.

Exercise load management is vital to the successful treatment of Achilles tendinopathy. Mild load increases stimulate new tendon growth; overloading can lead to further tendon deterioration. Tendons have a latent response to loading, meaning that you will be guided by how the tendon responds, not just immediately, but up to 24 hours later or more. It is important to modify your activity to remain pain-free during and after the following 24-48 hours.

We utilise a range of additional interventions and management strategies, including but not limited to physical therapy, custom orthotics, footwear modifications and refer if needed for shockwave therapy and PRP injection therapy to reduce strain while the tendon heals.

Non-surgical Treatments

Limit Activity - avoiding or severely limiting activities that may aggravate the condition, such as running.
Icepacks - applying icepacks for 20 minutes per hour while the injury is painful.
NSAIDs - taking a short course (7-10 days) of non-steroidal anti-inflammatory drugs in consultation with your doctor.
Heel lifts - decrease the strain on the Achilles tendon by raising the heel.
Physical therapy - including appropriate warm-ups, cool-downs and stretches, as well as resistance exercises.
Orthoses - using shoe inserts (orthoses) to take pressure off the tendon as it heals. In cases of flat or overpronated feet, our podiatrists may recommend long-term use of orthoses.
Shockwave therapy - a non-invasive procedure where sound waves are used to accelerate healing by stimulating blood flow, breaking down scar tissue, calcifications, and reducing pain.

Surgical Treatment

Achilles tendinitis surgery is only recommended if all other treatment strategies have failed. In this case, badly damaged portions of the tendon may be removed. If the tendon has ruptured, surgery is necessary to reattach the tendon.

What to Bring to My Appointment

Please bring the following information to your appointment:

List of symptoms: A timeline of how and/or when the pain started, and when it feels better or worse (e.g. stairs, running, waking up).
Medical history: A list of any previous injuries, relevant surgeries, and current medical conditions.
Current medications: Dosages for pain relief or anti-inflammatory drugs you are taking.
Primary shoes: The shoes you wear the most often (walking or running shoes), so our podiatrists can check for wear patterns.

Do Not Ignore Achilles Tendinopathy

It is important to contact a podiatrist about your symptoms early. Ignoring early symptoms is dangerous, as Achilles tendinopathy rarely resolves on its own. What starts as a simple issue often progresses into a chronic, debilitating condition. Continued overloading of the tendon risks partial or complete tendon rupture, which can cause permanent damage and requires surgical intervention. Secondary compensatory injuries can also occur from changes to your gait, such as knee, hip, and back pain, or plantar fasciitis.