Problems that affect the Achilles tendon are common among active adolescents and young athletes. The Achilles tendon is the large tendon, located at the back of the ankle, that inserts into the heel bone. The Achilles tendon connects the leg muscles to the foot and gives us the ability to push off during walking, running and jumping activities.
Achilles tendinopathy occurs due to a series of micro-tears in the tendon that weaken the tendon, resulting in localised swelling and pain with running and jumping sports. Until recently Achilles Tendinopathy was commonly referred to as Achilles Tendonitis.
What causes Achilles Tendinopathy?
There are several factors that may contribute to the development of Achilles tendon problems in young people:
- Increase in sports training routine: a sudden increase in the intensity, frequency or duration of sporting activity or a decrease in recovery time between training sessions
- Inadequate warm up, stretching, or cool down after sport
- Excessive hill running – this puts the Achilles tendon on maximum stretch
- Abnormal foot posture (eg flat feet, overly-pronated foot types, high-arched feet)
- Unsupportive footwear
- Poor muscle flexibility (eg tight calf muscles)
- Decreased joint range of motion (eg stiff ankle joint)
- Weak calf muscles
What are the signs and symptoms of Achilles Tendinopathy?
The pain caused by Achilles tendinopathy can develop gradually and may initially be experienced only after sport. As the injury worsens, pain is often felt during sporting activities and may also be present during normal daily activities.
The most common symptoms of Achilles tendinopathy include:
- Pain and tenderness in the Achilles tendon area behind the ankle, especially if you pinch the tendon between your fingers
- Swelling around the tendon
- Stiffness and pain most noticeable in the morning on first arising
- Weakness when hopping, jumping or skipping on the affected leg
How is Achilles Tendinopathy diagnosed?
Your Podiatrist will take a comprehensive medical history and perform a physical examination and gait analysis. The assessment will include:
- Pain provocation tests (tendon palpation, skipping, hopping etc)
- Foot posture assessment
- Joint range of motion (flexibility)
- Foot and leg muscle strength testing – looking for any muscle imbalance or weakness
- Footwear assessment
- Gait analysis and biomechanical assessment of the feet and legs – to look for any abnormalities in the way the feet move during gait
- A soft tissue ultrasound scan may also be required to look more closely at the tendon
How is Achilles Tendonitis treated?
Treatment for Achilles tendinopathy in young people is most effective when this condition is treated early and may include a combination of the following:
- Rest – from aggravating activities (eg. running, jumping, skipping) until your child is able to walk comfortably without pain
- Footwear changes – changing to a high quality, stable shoe will help to absorb shock and support and stabilise the feet
- Foot orthotics – to improve your child’s foot posture and reduce strain on the Achilles tendon
- Home Exercise Program – exercises to stretch and strengthen the Achilles tendon, calf and foot muscles are an integral part of the treatment plan and will reduce the likelihood of injury recurrence
- Joint Mobilisation – in addition to a stretching program, joint mobilizations can help to improve foot and ankle flexibility
- Massage Therapy
- Medication – sometimes a short course of non-steroidal anti-inflammatory medications (eg. Voltaren, Nurofen) can be a helpful short-term adjunct in reducing inflammation and pain
Return to sports training should be gradual and guided by your Podiatrist.
What should I do if my child has Achilles tendon pain?
If your child is experiencing Achilles tendon pain, or you are concerned about their gait or foot posture, don’t hesitate to consult with our experienced paediatric podiatrists for a comprehensive walking assessment and professional advice.