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Achilles tendinopathy is a condition that causes pain, swelling and stiffness of the Achilles tendon. The true cause is not known, however it is thought to be multifactorial. However, repeated tiny injuries (microtrauma) to the Achilles tendon are thoguht to be the cause. After each injury, the tendon does not heal completely. Over time, damage to the Achilles tendon builds up and Achilles tendinopathy develops.

Many factors cause tiny injuries to the Achilles tendon.

Overuse of the Achilles tendon. This can be a problem for people who run regularly. (Achilles tendinopathy can also be a problem for dancers and for people who play a lot of tennis or other sports that involve jumping.)
Training or wearing inappropriate footwear.
Poor training or exercising techniques.
Changes to your training programme – rapidly increasing the intensity of your training and frequency
Training or exercising on hard or sloped surfaces
Achilles tendinopathy is also more common in people with ankylosing spondylitis or psoriatic arthritis. It is also more common in people who have high blood pressure, high cholesterol/lipids or diabetes

People who take certain medications sucha as fluoroquinolones (ciprofloxacin and ofloxacin) also have an increased risk of developing Achilles tendinopathy.

Achilles tendinopathy used to be known as Achilles tendonitis.

However, Achilles tendinopathy is now thought to be a better term to use because it is thought that there is little or no inflammation that causes the problem.

How common is Achilles tendinopathy?
Achilles tendinopathy affects more than 150,000 people in the UK every year. It’s becoming more frequent. It can be a particular problem for long-distance runners, dancers and tennis players.

What are the symptoms of Achilles tendinopathy?
The main symptoms include pain and stiffness around the affected Achilles tendon. Pain and stiffness tend to develop gradually and are usually worse when you first wake up in the morning.

Some people have pain during exercise and after exercise. Runners may notice pain at the beginning of their run, which then eases to become bearable.  There may also be some swelling around this area.

Do I need any investigations?
Diagnosis of Achilles tendinopathy can be made based on typical symptoms and from examining your Achilles tendon. They may feel for swelling or tenderness of the tendon. Most people with Achilles tendinopathy movement reproduces their pain.

You may need tests to rule out underlying causes such as high cholesterol or diabetes.

X-rays or other tests are not usually needed to diagnose Achilles tendinopathy. However, an ultrasound scan or an MRI scan may sometimes be suggested by a specialist if the diagnosis is not clear.

What is the initial treatment for Achilles tendinopathy?
A number of treatments that may help. The treatments below are usually suggested first. They are all considered as conservative treatments.

Rest and time off from sporting activities are important if you have Achilles tendinopathy. At first, you should stop any high-impact activities or sports (such as running). As pain improves, you can restart exercise as your pain allows.

Painkillers such as paracetamol or ibuprofen may help to relieve pain. However, you should not use ibuprofen or other NSAIDs for more than 7-14 days if you have Achilles tendinopathy.

Ice packs
Ice treatment may be useful for pain control and may help to reduce swelling in the early stages of Achilles tendinopathy. An ice pack should be applied for 10-30 minutes. Less than 10 minutes has little effect. More than 30 minutes may damage the skin. Make an ice pack by wrapping ice cubes in a plastic bag or towel. (Do not put ice directly next to skin). Gently press the ice pack on to the injured part. The cold from the ice is thought to reduce blood flow to the damaged tendon which may reduce pain.

Achilles tendon exercises
Exercises to help to stretch and strengthen your Achilles tendon have been shown to be helpful. Exercises may help with pain control and stiffness. Treatments such as ultrasound and massage to help relieve symptoms and promote healing of your Achilles tendon.

An orthotics specialist may suggest changing your footwear or putting special inserts in your shoes, such as inserts to lift your heel. This may help to reduce pain and symptoms.

Why we donot use steroid injections
Injection of a steroid is a common treatment for some tendon injuries. However, the use of steroid injections for the treatment of Achilles tendinopathy is controversial and it is not approved in the UK. If steroids are injected directly into the Achilles tendon, there is a risk of damaging the tendon further. There have been cases where they have caused the tendon to tear (rupture).

Specialist treatments that are not surgery
There are some treatments that some specialists may suggest to help treat Achilles tendinopathy. You should discuss these treatments fully with your specialist, including their pros and cons, before any treatment is started. These treatments may not be widely available on the National Health Service (NHS). Some may also be carried out as part of a trial to look at the best ways of treating Achilles tendinopathy. Such treatments may include:

Extracorporeal shock-wave therapy

Special sound waves are passed through your skin to your Achilles tendon. Side-effects can include reddening of your skin and an ache in your calf after treatment. This procedure is generally safe but there is a small risk of tearing (rupturing) the Achilles tendon with this treatment, particularly in older people. How effective this treatment is, is not known The National Institute for Health and Care Excellence (NICE) recommends specialists discuss this treatment fully before it is started.

Injection using your own blood/PRP

it is possible for a specialist to take some of your own blood (in the usual way) and to inject this around your Achilles tendon. This is called autologous blood injection/or platelet rich plasma. This helps to promote healing of your damaged tendon by encouraging the growth of cells involved in the healing process. Ultrasound scan to help guide their injection. However, at the moment, it is not clear whether this treatment is effective or what the long-term effects are. For this reason, NICE suggests that this treatment should only be carried out if you are fully aware of this.

Surgery for Achilles tendinopathy
Around 1 in 4 people who have persisting pain due to Achilles tendinopathy have surgery to treat the condition. Most people have a good result from surgery and their pain is relieved. Surgery involves either of the following:

Removing nodules or adhesions (parts of the fibres of the tendon that have stuck together) that have developed within the damaged tendon and/or making lengthways cuts in the tendon to help to stimulate and encourage tendon healing. Complications from surgery are not common but, if they do occur, can include problems with wound healing.