By Dr Chris Milne, Sports Physician

1. What is it?

It is a disruption of some of the fibres of the achilles tendon. There may be some minor inflammation, but not as much as previously thought.

2. What causes it?

Overuse, plus some wear and tear disruption of the tendon. Poor alignment through the foot and ankle can play a part.

3. Symptoms – What you notice

• Pain – Usually worse with activity over a 2-3cm length of tendon.
• As the pain progresses you find you are unable to run as far before it comes on, and the pain may stick around for an hour or two after exercise.
• Usually there will be localised swelling at the painful site.

4. Signs – What the doctor finds

• Swelling – usually spread over a 2-3cm length of tendon.
• Tenderness – at the painful site in the tendon.
• Occasionally there may be a small very tender nodule at 0.5cm in size. This may indicate a small partial tear.
• Often associated with flat feet and over-pronation.

5. Investigations

An ultrasound scan may show the amount of fibre disruption. It can also show up a partial tear of the tendon, or associated peritendinitis. If there are significant new vessels, then adjunctive treatment may be required.

6. Treatment

• First aid – ice massage and Voltaren Emulgel are useful. If you are away from home, use some crushed ice or a packet of frozen peas wrapped in a towel.
• Rest from running until the initial soreness subsides. You should be able to continue swimming or cycling, plus gentle walking.
• Once the initial soreness has settled (usually after a week or two) you should start a progressive strengthening programme as below (see recovery sequence Step 3).
• If you have flat feet and have not been supplied with orthotics, a podiatry consultation will probably be arranged.
• If the achilles tendon is not improving despite good adherence to the calf strengthening programme of 90 repetitions per day, adjunctive treatment may be required.
• Surgery is only required if there is a significant partial tear, or if the problem has not settled much over 3-6 months.

7. Recovery time

Average recovery time is 2-4 months.

8. Recovery sequence

• Step 1 Ice packs, Voltaren Emulgel.
• Step 2 Physiotherapy – advice regarding stretching and strengthening exercises. Ultrasound therapy may be useful in some cases.
• Step 3 Progressive strengthening exercises (calf raises). Start with both legs together, and build up progressively until you can manage 3 sets of 15 single leg calf raises twice a day (90 calf raises a day). Do these off the back steps of your house.
• Step 4 Continue swimming and cycling as much as the pain will allow.
• Step 5 Restart running, beginning slowly on grass for 5-10 minutes, and build up your normal training over the next 2-3 months.