This section describes some of the most common causes of achilles pain, including achilles tendinopathy and achilles rupture.
Tendons are tough bands of tissue that connect muscles to bones and therefore allow movement of your joints. Tendinopathy is what happens when these tendons become dysfunctional. The Achilles tendon is the largest tendon in the body and is commonly affected by this condition. There are several stages of tendinopathy which your physiotherapist will explain, and it is very important to seek treatment in the early stages as without appropriate advice and exercise your problem could become a lot worse later on in life. Initially, the tendon may become painful due to being overloaded to a point that is greater than it can handle, e.g. a particularly long and hilly walk/run or a hard game of netball. Given some rest and appropriate treatment, this type of injury should completely resolve, with little long-term effects. If this problem persists and training/exercise continues, it is possible that pathological changes can occur within the tendon, with changes to the way the collagen is structured in the tendon. In the long-term this can lead to a degenerative tendinopathy which becomes more difficult to resolve due to structural changes in the tendon. Your physiotherapist will assess what stage you are in and then design a treatment plan that is most appropriate for this stage. This may involve advice on the type of training you can do, specific exercises you can do to stretch and/or strengthen the tendon, soft tissue and joint mobilisation to free up the area, biomechanical assessment, and podiatrist referral. Once you can tolerate it, you will need to begin specific and graduated strengthening of the tendon so that it can withstand increased loads. Without a good exercise programme the pain is likely to return once you get back to training. Tendons are very susceptible to changes in load, and therefore need a relatively long time to adapt to the exercises that your physiotherapist will prescribe.
As well as being prone to tendinopathy, the achilles tendon can also completely tear or rupture during a sudden injury. This is most common in high intensity sports like rugby, basketball, netball, badminton or squash. Often it will feel as though you have been kicked in the back of the leg and then you will be unable to push off with your toes. There will be significant swelling, and your physio should be able to diagnose this problem from a few simple tests. An ultrasound scan can help confirm the diagnosis. You will need to be referred to see an orthopaedic surgeon as soon as possible who will decide whether to operate or not. Older and less active people are less likely to require surgery, but it is imperative to be diagnosed and treated early to have successful non-operative treatment. Regardless of whether you have surgery or not you will need to do a long period of rehabilitation to regain your strength, flexibility, endurance, and power in the leg. It is important to have your rehabilitation supervised by an experienced physio and you can expect it will take 6-9 months before you can return to sport.