This month Tina Parkes Blewett one of our physiotherapists writes on one of her areas of expertise, the Achilles’ tendon.
She finds many patients ask her: “How can I help the pain that I feel in the tendon at the back of my heel, as I really want to start exercising again but my heel is so stiff and sore in the morning?”
The usual cause is Achilles tendinopathy, an overuse injury causing pain, inflammation and/or wear and tear of the large Achilles tendon at the back of the ankle.
The Achilles pain can come on suddenly and be very painful, or it can come on more gradually and get worse over weeks but not so sore to stop you doing things.
Typically you feel the back of your ankle is stiff and sometimes painful in the morning and eases as you walk around because everything warms up.
Signs of Achilles problems are that the tendon starts to become thickened about 3cm above the heel and will be tender to touch. Mostly you can bring on the pain if you suddenly start doing more like increasing the speed you run at, running further or walking/running up hills which you do not usually do.
If you want to increase the distance you run or walk then you should really limit any increase in distance to ten per cent per week.
Individuals with flat feet are more likely to suffer from Achilles tendinopathy.
In this case orthotics (inserts) can be worn, but choosing shoes or trainers that support the arch of the foot will help. Also, ladies who only wear high heels, shorten the length of the calf muscle and therefore the tendon so if they suddenly change to flat shoes (like flip-flops in the summer) the tendon will get irritated because it’s not used to it.
The best treatments are; identifying the cause of your pain and then reducing any inflammation with rest, ice, anti-inflammatory tablets if you can take them (check with your GP or the pharmacist), and possibly initially a heel raise to reduce the stretch on the tendon.
Physiotherapy exercises then start to lengthen any tightness, strengthen any weaknesses and work on any other areas of the body such as hip, core weakness (specialised tummy muscles) and spinal stiffness probably caused by poor running and walking postures (Pilates can really help with this - see January’s article).