As a doctor who specialises in diagnosing and treating foot and ankle problems, I see a lot of people who are struggling with a painful, swollen Achilles tendon.
Tendons connect bone to muscle and are heavily involved in helping to cause movement when our muscles are contracted or relaxed. The Achilles tendon is the largest tendon in the body and connect the calf muscle to the heel. It is used whenever you undertake weight bearing activities such as walking, running, stair climbing and so forth.
When the Achilles tendon is weakened over time or as a result of heavy use, small (or large) tears can occur in it, causing pain and swelling. This is known as Achilles tendinopathy.
Achilles tendinopathy is one of those conditions where you don't fully appreciate how frustrating and limiting it can be until you have it yourself!
Most of us move around every day with minimal awareness of the work our heels and ankles are doing; I can guarantee that somebody with Achilles tendinopathy is extremely aware of them. Even the simple act of walking can cause really quite significant pain and discomfort.
Many of the people I see with Achilles tendinopathy are keen sportspeople. The Achilles tendon is placed under significant load during sports involving repetitive impact work (for example, those involving jumping movements). Having said that, Achilles tendinopathy is not a problem exclusive to people who play sports and it can occur in people of all ages and activity levels.
Fortunately, it is usually very simple for me to diagnose Achilles tendinopathy from talking with you about your symptoms and carrying out an examination. By gently pressing on the affected area, I will be able to determine the location of any pain, tenderness or swelling you have.
The most common indicators I'll be looking for are pain around the Achilles tendon and a thickened tendon. The type and severity of the pain will differ for each person, ranging from sharp and severe to dull and generalised.
Many people tell me they feel the worst symptoms the morning following exercise, a result of the Achilles tendon becoming stiff overnight.
You may need additional diagnostic scans to assess for other co-existing problems around the tendon.
There are a few different treatment options available for Achilles tendinopathy, conservative (non-surgical) and surgical. I will always advise non-surgical treatment first.
Physiotherapy can be very good at helping relieve your symptoms (i.e. getting you out of pain) and helping to prevent future damage to the tendon. Your physiotherapist will be able to show you gentle stretching and strengthening exercises to carry out that will normally be very helpful. Using a heel lift insole is an effective way of off-loading the tendon, which will help reduce the pain further.
Pain relief medication and anti-inflammatories can also be of help and I'll talk with you about this when we meet. If these simple measures do not help, ultrasound therapy (shockwave) or a high-volume injection around the tendon may be recommended.
If the damage to your tendon is more significant and conservative treatment is ineffective, surgery may be needed. Should this be the case, I will talk you through the operation, explaining how it will be done and what you should expect you recovery to be like. The decision to have surgery is always yours to make, I will help ensure you have all the information you need to make an informed choice.
Your consultation is also a very good time to ask me any questions you have about treatment options, or to talk through any concerns with me. I am always happy to help.
Pain and swelling in the Achilles tendon can have a surprisingly big impact on our ability to walk, to move and to take part in everyday activities and sports.
When the pain is mild or intermittent, it can be easy to ignore it and put off getting it treated. When it becomes more painful, or painful for longer, most people start to think about getting expert help!
If you're at the stage of looking for help, it is very easy to arrange to see me at Circle. My private secretary will be delighted to schedule a time that's convenient for you. When we meet, I'll talk about your symptoms with you and will examine your foot and ankle to assess things. Once we know exactly what is causing your pain, I'll talk with you about the most suitable treatment options, so that you can decide what would be best for you.
A painful Achilles tendon can be frustrating and limiting. I will help get you out of pain so that you can get back to your normal activities again as soon as possible.