Achillodynia is a chronic change of the Achilles tendon. This is the attachment tendon of our calf muscles and is inserted in our heel bone. Long-term incorrect loading leads to inflammation of the tendon.
The disease occurs particularly frequently among athletes. In almost half of the cases, the Achilles tendon is affected on both sides. The tissue of the tendon changes (degeneration).
Small nodules can develop, the blood flow situation of the vision changes, the tendon becomes doughy and finally hardens. It hurts and increasingly loses its resilience. The risk of a rupture of the Achilles tendon increases.
The pain often occurs in relation to stress and disappears again after resting. The therapy can usually be performed conservatively. In addition to physiotherapy, an examination of the sports materials is also indicated. Since this is a chronic disease, a long-term therapy course is necessary to alleviate the symptoms.
Therapy
The therapy is usually conservative. During acute symptoms, the first step is to relieve and spare the Achilles tendon. This can be done by simple immobilization and protection by the patient, but can also be supported by splints or tape bandages.
In addition, the therapy can be supported by the administration of non-steroidal anti-rheumatic drugs (Diclofenac, Ibuprofen, etc.). In the following, we will carefully try to mobilize the tendon again, improve its care, make it more resilient and restore its function. This is done through intensive physiotherapy.
The contents of the physiotherapeutic therapy for Achillodynia are active and passive stretching of the tendon and calf muscles including intensive soft tissue treatment, a check to see whether muscular imbalances are present, a correction of the running style and, if necessary, a check of the footwear. The application of Kinesiotape can support the healing of the tendon. Mobilization of the tendons is achieved on the one hand by soft tissue treatment by the therapist using transverse stretching and trigger point therapy, and on the other hand by active specific stretching exercises.
The eccentric strength of the tendon (the muscle is slowly lengthened in a controlled manner under load) is trained, and the tendon is stretched by the body weight. More exercises can be found in the articles:
- Achillodynia Physiotherapy
- Physiotherapy for Achilles tendon inflammation
- Physiotherapy for foot and ankle diseases
1.) The patient stands with both feet on a quilting board or a step.
Only the forefoot stands on the pad, the heels hang freely. Now the patient presses himself with the healthy foot into the toe position. The affected foot can also be lifted during this time, it should not help to push up under any circumstances.
From the toe position now, the healthy foot can be lifted, or at least the body weight should be shifted to the affected foot. Now the patient lets the heel of the affected foot sink very slowly and in a controlled manner, so that the calf stretches slowly, this requires eccentric muscle work of the calf muscles. The heel is lowered below the level of the step so that the calf muscles are stretched.
The stretching position can be held for a few seconds before the healthy foot presses the body back into the toe position. The exercise is performed with 15 repetitions in 3 sets 2-3 times a day. As this is a chronic condition, it may take some time for the achillodynia to disappear or improve.
If the symptoms are resistant to therapy, surgical therapy can be performed. Subsequently, the function of the tendon is restored by physiotherapy. Further exercises can be found in the articles:
- Achilles tendon stretching exercises
- Achilles tendon pain – exercises
In rare cases, surgical intervention may be necessary to treat achillodynia.
This is especially the case when a long-term conservative treatment has not been successful. There are several surgical options. Either the outer skin around the tendon is split to promote wound healing and the formation of new healthy tissue.
Or the altered tissue is completely removed (debridgement). There is always the risk of scarring during surgery. Scar tissue is less flexible and resilient than the original tissue.
Therefore, movement restrictions or adhesions can occur. In order to prevent this, physiotherapy should always be performed after an operation. The symptoms of achillodynia may persist after the operation.Physiotherapeutic treatment should always be continued even after surgery.
There is the possibility to support the healing of an achillodynia by means of adapted insoles. For example, there are insoles that make it easier to roll, there are insoles that are specially tailored to the patient to reduce pain under stress. Some manufacturers recommend shoes that go over the ankle in order to stabilize the ankle joint.
The arches of the foot can also be specifically supported in this way to relieve the tendon and thus reduce pain. Insoles can only be seen as a supplement to therapy, intensive physiotherapy cannot be replaced by insoles. However, insoles are useful to relieve the overstrained tendon in everyday life and reduce symptoms.
Tape bandages can be used in cases of achillodynia. There are basically two types of tape systems. On the one hand there is the so-called classical tape, which is inelastic and firm.
It is used for stabilization and can protect a joint from undesirable movements. On the other hand there is the so-called kinesiotape. This tape is elastic and allows movement to a large extent.
It has an effect on the muscles and ligaments, and promotes self-perception (proprioception), it can reduce swelling and increase blood circulation. Both tapes can be used in case of achillodynia. In the acute stage, when immobilization is required, the ankle joint can be fixed with classical tape.
More important is the support of the healing process by applying Kinesiotape. By selective placement of the plaster strips, the tendon can be relieved and wound healing can be promoted. The muscles can relax and the tendon is less stressed. A tape should be explained by a specialist, but can then be applied by a partner or, if necessary, even independently by the patient.