The Long Haul
Aug 9, 2017 · 2 min read

Achilles Tendinopathy in Runners

The Achilles Tendon can be a troubling area for runners. This tendon is the structure at the back of the heel which connects the gastrocnemius and soleus muscles commonly known as the calf, to the calcaneus, the ankle bone which it attaches to. The Achilles can become susceptible to injury in both the athletic and sedentary populations, and can be either acute or chronic.

What is tendinopathy?

By definition, tendinopathy is a diseased tendon. This is differentiated from tendonitis, which is inflammation of a tendon. Achilles tendinopathy is when the tendon thickens in response to repeated use, and can undergo degenerative changes. Achilles tendinopathy can be further differentiated into insertional versus non-insertional tendinopathy, depending on location of the injury. Insertional tendinopathy occurs where the tendon inserts at the base of the heel, and is the more common site of trouble for athletes (Li and Hua).

What are the symptoms?

Often runners experience gradual onset of pain at the Achilles tendon, and the area can become swollen and tender to touch. Activities that stress the tendon such as hill running, squatting, and calf raises can be painful.

What makes me at risk for Achilles pain?

Injury risk factors include recent increase in training, training on hard surfaces or inclines, being over 30 years, being of the male gender, having pes cavus (a high arch), and being overweight (Maffulli et al.). Repetitive micro trauma, which can occur with distance running, can contribute to injury. Additionally, different running gait styles can stress the tendon. For example, over pronation or inappropriate timing of pronation can increase the susceptibility to Achilles tendinopathy. Prior history of injuries or ankle instability can further put the athlete at risk (Maffulli, et al.).

What are my treatment options?

Treatments vary based on the severity of the injury. The first line of treatments include rest, activity modification, icing, stretching, massage, and anti-inflammatories for symptomatic relief. Calf tightness can cause the Achilles to become painful, therefore, a calf stretching program can benefit. In some cases, a medical provider may order an MRI or ultrasound of the tendon. Runners may be encouraged to correct gait alignment errors, change their running shoes or add orthotics, or correct muscle imbalances.

In a recent study, patients with noninsertional Achilles tendinopathy were treated with topical glyceril trinitrate and the effectiveness of treatments were assessed after 3 years of treatment via pain scores and clinical exam. Application of glyceril trinitrate, a potent vasodilator, to the hypovascular area helped to recruit blood flow and help the tendon to heal. However, in more persistent cases, surgical excision of the diseased Achilles tissue may be required.

References

Maffulli, N., Sharma, P., & Luscombe, K. L. (2004, October). Achilles tendinopathy: aetiology and management. Retrieved August 09, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1079614/

H. (2016, November 03). Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments. Retrieved August 09, 2017, from https://www.hindawi.com/journals/bmri/2016/6492597/

The Long Haul

Written by

Fiona Nugent, Sports Medicine Nurse Practitioner | Columbia University Sports Medicine | Endurance running injury prevention, diagnosis, management