1. What is it?
The Achilles tendon is the common attachment point for the gastrocnemius and soleus muscles to the heel. It is the thickest and strongest tendon in the body. Injury to the tendon is an overuse injury that involves a localized inflammatory response due to repetitive microtrauma. Achilles tendinitis accounts for up to 11% of all running injuries.
2. What are the causes/predisposing factors of injury?
Abnormal foot pronation, high arches, leg length inequalities, structural misalignments, bowed legs, excessive toe running, inadequate heel support and muscle strength and flexibility imbalances especially of the calf muscles, can lead to this injury. Other factors than can contribute to the problem include: changes in training routine, training errors, improper footwear or fatigue.
3. What are the symptoms?
Persistent pain at the back of the ankle is the general symptom. The pain may lessen with activity, but return after activity. Periods of inactivity may also aggravate the symptoms. Some localized swelling and tenderness may be noted.
4. What can be done to prevent or treat the injury?
Prevention is geared towards nullifying the predisposing causes. For example, good motion control footwear is essential for those with pronation problems. Stretching the calf muscles before and after running helps reduce the tension of the tendon. Strengthening the calf muscles enables the muscles to perform properly without early fatigue which can lead to altered biomechanics and perhaps injury.
Treatment encompasses the same principles as prevention with the addition of physical therapeutics to aid in healing. Steps that the injured runner can take include: cutting back on mileage, using ice packs to reduce inflammation after running, heel lifts to reduce tension on the tendon and gentle stretching of the calf muscles. Other treatments such as ultrasound to speed healing, electrical stimulation to return muscle tone and strength to normal, ankle bracing during vigorous activity and cross friction massage may also be used if the injury is severe or persistent.