Achilles Tendinopathy

What is Achilles Tendinopathy?

A tendinopathy occurs when a tendon fails to heal after an overuse injury. This causes pain and swelling of the tendon and often results in a limp, lack of function and stiffness.

Achilles tendinopathy can affect the tendon where it inserts into the heel bone (insertional tendinopathy) or in its middle (mid-substance tendinopathy). This already common tendinopathy seems to be becoming more common as more people participate in sports activities, particularly if they train heavily or incorrectly. It is seen particularly in runners and in those with abnormal foot posture.

How is Achilles Tendinopathy diagnosed?

The diagnosis of the Achilles tendinopathy condition is usually fairly straightforward but we often recommend an ultrasound scan to confirm the degree and precise location of tendinopathy.

How is Achilles Tendinopathy treated?

Achilles Tendinopathy treatment involves firstly identifying and correcting any causative factors, using painkillers and rest as necessary and doing specific physiotherapy stretches and exercises (eccentric programme).  Splints may also be recommended. GTN (glyceryltrinitrate) patches can also be tried.

Unfortunately, the condition can often fail to respond to these measures, and we see many patients who have suffered with the condition for over a year and who have been unable to participate in their usual recreational activities and whose daily lives are made difficult because of the pain.

What if these don’t work?

In longstanding (chronic) cases that have not responded to the other treatments, we first recommend shock wave therapy (radial or focussed) as it is a non-invasive, needle-free outpatient procedure that is well tolerated and successful in relieving pain in 80% of cases.

Other tendinopathy treatments are available for chronic tendinopathy, such as PRP (platelet-rich plasma) injections and, as a last resort, mini-incision day-case surgery. We rarely have to resort to these.


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