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Achilles tendinopathies (AT) encompass inflammation (tendinitis) or fibrosis/scar (tendinosis) of the Achilles tendon. 1 A tendinopathy is a degenerative state of the tendon. A typical cause of AT is the application of repetitive and or excessive loads to the achilles tendon. An increase in the prevalence of AT has been reported in the last 10 years. 2 Achilles tendinopathies reportedly comprise 6.5% of all running injuries.
Abnormal biomechanics such as overpronation (flat foot) places an asymmetrical stress on the achilles. The tendon “bows” with a convexity medially (toward the inside) and a concavity laterally (toward the outside). The turned-in position of the heel will increase strain medially and slacken the achilles laterally. The soleus and gastroc, the two parts of the calf muscle, share the achilles tendon as their insertion into the back of the heel bone. The soleus is active as a stabilizer while we stand. The gastroc is most active during the push-off phase of gait. The activity in both muscles is exaggerated during weight bearing sports especially tennis and basketball where play entails excessive positioning on the balls of the feet. The literature contains many references to articles that try to control the forces on the Achilles tendon through heel lifts, foot orthotics, and taping techniques.⁴ Although there is variable evidence regarding the efficacy of these strategies, anecdotal reports suggest the effectiveness of these interventions. At Walk Well Rehabilitation, we not only read the evidence, we scrutinize it!
Principles of Treatment:
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