The term Achilles heel derives from Greek mythology when a great warrior Achilles was dipped in water as a baby which was supposed to make him invincible, unfortunately as his mother dipped him in, she held him by the heel Which wasn’t washed over. This became his weak spot and ultimately led to his downfall.
Unfortunately for most runners and triathletes who suffer from Achilles pain the duration can also be EPIC!
It is one of the most common weak spots in the body for overuse injuries and will usually be classified as one of 3 diagnosis’s
– Achilles tendonosis : this involves degeneration and some inflammation of the tendon itself. Its shape changes from that of a thin pencil like shape to an overall thickening along the tendon.
– Achilles paratendonitis : the paratendon is a sheath that encloses the tendon and should provide protection and allow fluid movement of the tendon. Unfortunately symptoms of inflammation and swelling can develop between the tendon and the sheath this can cause scar tissue and reduces the tendon mobility.
– A combination of the 2 above.
Very often with this the key to recovery is not just physiotherapy assessment and treatment but also evaluating the causes of it. These may include:
Biomechanical faults ( usually over-pronation)
Poor footwear ( digging into heel)
Direct injury or previous unresolved injury
Changes of running surface
Tight and or weak calf muscles
Commonly when athletes self diagnose and treat they get stuck into copious amounts of eccentric exercises ( heel drops with a gorilla on their back) and can often aggravate the complaint.
That is not to say eccentrics are not appropriate, just they need to be added to a rehabilitation program when appropriate i.e. when the basic calf mobility and strength is returning and the tight calf muscles have been released. Along with specific soft tissue treatment to the tendon.
Occasionally these injuries require a full podiatry assessment and orthotic prescription and if they fail to recover an ultrasound scan via a radiologist who may administer high volume saline injections to break up scar tissue between the para-tendon and the tendon.