Achillodynia: Causes, Symptoms & Treatment
Achillodynia refers to pain in the area of the Achilles tendon. It is often caused by overuse and primarily affects athletes and physically active individuals.
Things worth knowing about "Achillodynia"
Achillodynia refers to pain in the area of the Achilles tendon. It is often caused by overuse and primarily affects athletes and physically active individuals.
What is Achillodynia?
Achillodynia is a general term for pain conditions affecting the Achilles tendon, the strongest tendon in the human body. It connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). Pain in this region can involve the tendon itself or the surrounding tissue and is most commonly caused by overuse or mechanical overload.
Causes
Achillodynia is usually the result of several contributing factors:
- Overuse: Intense or suddenly increased training, particularly running
- Foot or leg malalignment: Flat feet, leg length discrepancy, or abnormal gait mechanics
- Inadequate warm-up: Insufficient stretching of the calf muscles before exercise
- Inappropriate footwear: Shoes that are too rigid or poorly fitting
- Metabolic conditions: Such as gout, diabetes mellitus, or elevated cholesterol
- Medications: Certain antibiotics (e.g. fluoroquinolones) can damage tendon tissue
- Age-related changes: Reduced tendon elasticity with advancing age
Symptoms
The typical symptoms of achillodynia include:
- Pain in the Achilles tendon region, most commonly 2–6 cm above the heel bone
- Start-up pain: Pain at the beginning of movement that improves after a few steps
- Pain after prolonged activity or in the evening
- Morning stiffness and pain upon first standing after sleep
- Swelling, warmth, or a palpable thickening of the tendon
- Tenderness when pressing directly on the tendon
Diagnosis
Diagnosis is usually made through a clinical examination. The physician reviews the patient's complaints, exercise habits, and medical history. The following investigations may be used:
- Ultrasound (sonography): To visualise changes, tears, or thickening of the tendon
- MRI (Magnetic Resonance Imaging): For detailed assessment in unclear cases
- X-ray: To rule out bony changes or calcifications
- Laboratory tests: If metabolic or inflammatory conditions are suspected
Treatment
Conservative Treatment
Most cases of achillodynia respond well to conservative measures:
- Load reduction: Temporary rest and adjustment of training volume
- Eccentric strength training: Targeted training of the calf muscles, considered the most effective conservative method (Alfredson protocol)
- Physiotherapy: Stretching, manual therapy, and gait retraining
- Orthotics and insoles: Heel wedges or custom insoles to offload the tendon
- Cooling: Local cold application to reduce pain and swelling
- Pain relief medication: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for acute complaints
- Shockwave therapy: Use of acoustic waves to promote tissue healing
Surgical Treatment
If conservative methods fail to provide relief after several months, surgical intervention may be considered. This typically involves removing degenerated tendon tissue or correcting structural causes.
Prevention
The following measures are recommended to prevent achillodynia:
- Regular stretching of the calf muscles
- Gradual increase in training intensity and volume
- Appropriate, well-cushioned sports footwear
- Strengthening exercises for the lower extremities
- Adequate recovery time between intensive training sessions
References
- Maffulli N, Wong J, Almekinders LC. Types and epidemiology of tendinopathy. Clinics in Sports Medicine. 2003;22(4):675–692.
- Alfredson H, Pietila T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. American Journal of Sports Medicine. 1998;26(3):360–366.
- Kearney RS, Parsons N, Costa ML. Achilles tendinopathy management: a pilot randomised controlled trial comparing platelet-rich plasma injection with an eccentric loading programme. Bone and Joint Research. 2013;2(10):227–232.
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