Complaints about the Achilles tendon (Achillodynia) are particularly common among athletes

Early and optimal treatment of Achilles tendon irritation helps to avoid permanent damage.

How does achillodynia occur – irritation of the Achilles tendon?

The Achilles tendon is the strongest tendon in the human body, but it is often exposed to great stress both in everyday life and in sport. Even in Greek mythology, it was considered the weak point of the otherwise invincible Achilles, and ambitious runners are often familiar with this problem. Particularly during greater running stress, so-called micro-injuries occur in the tendon, which are accompanied by an inflammatory stimulus. If the Achilles tendon does not have enough time to allow the body's own regeneration processes to take place or if the overload was too great, a so-called Achillodynia occurs.

Which factors promote the development of irritation of the Achilles tendon – Achillodynia?

Overloading the Achilles tendon (increasing the load too quickly during training, exceptionally steep mountain hikes, unusually long city tours…)
A shortening of the pelvic and leg muscles due to sedentary work or one-sided sporting stress without appropriate compensation
Running on hard surfaces or uneven ground
Expired footwear
Metabolic diseases, hyperacidity

What are the typical symptoms of Achilles tendon irritation – Achillodynia?

Typical symptoms of Achillodynia - irritation of the Achilles tendon are initially stress-dependent pain, usually a few centimeters above the heel ("midportion" Achillodynia), but it can also occur directly at the attachment of the Achilles tendon to the heel (near-insert Achillodynia). In the initial stages of Achilles tendon irritation, the focus is on so-called start-up pain at the beginning of a stress phase, which disappears during the course of training. Morning pain in the Achilles tendon and heel area is also typical. In the later stages of chronic achillodynia, the pain in the Achilles tendon persists during exercise and can even be increased after the exercise, so that stretching of the Achilles tendon can cause severe pain, for example when running or climbing stairs.

How is achillodynia - Achilles tendinopathy diagnosed?

First and foremost, it is a clinical diagnosis that is made by an experienced orthopedic surgeon based on the anamnesis and examination. In addition, ultrasound diagnostics with Power Doppler are used to determine the stage and extent of the irritation of the Achilles tendon and to select the optimal therapy regimen for treatment. For example, irritation of the Achilles tendon near the base is treated differently than “mid-portion” Achillodynia (3-4 cm above the heel). In addition, the degree of tendon damage or the neovessels growing into the tendon in the event of chronic Achilles tendon irritation is of great importance for the prognosis and classification in the therapy regimen.

An MRI of the Achilles tendon can be used to assess possible partial tears and their quantification.

Why is early treatment of Achilles tendon problems important?

Tendon irritations generally tend to become chronic; this is particularly true for the Achilles tendon, as it is subjected to a lot of physical activity. The longer such irritation of the tendon persists, the more pronounced the structural changes in the irritated Achilles tendon tissue. In particular, if small neo-vessels grow into the tendon due to chronic tendon irritation, the therapy becomes more complex and lengthy and the risk of suffering an Achilles tendon rupture increases the longer Achillodynia remains untreated.

What can you do yourself to relieve your Achilles tendon pain?

Firstly, it is essential that the load on the tendon is significantly reduced. Even if many athletes find this very difficult, they must temporarily switch to other training sessions and pay close attention to running style, shoes, surface and training intensity. In the acute stage, taking NSAIDs (ibuprofen, Voltaren, etc.) for a few days can also be useful, but this is generally not advisable for chronic Achilles tendon irritation, as it is not a prostaglandin-mediated inflammation. Regular cooling of the irritated tendon tissue in the form of intermittent cooling is also useful and temporarily alleviates the symptoms.

It is also extremely important to carry out a consistent and regular exercise program. You can find instructions for this under the links bellow.

Self-exercise programs for download:

Self-exercise Achilles tendon midportion Self-exercise Achilles tendon heel attachment

We help you alleviate the pain!

What does the treatment of Achilles tendon pain - achillodynia typically look like in our private orthopedic-osteopathic practice?

As holistically thinking orthopedists and osteopaths, we have developed a very effective therapy regimen in our practice for treating the various irritations in the Achilles tendon area and the various types of Achillodynia. Essential components of this therapy regimen are:
Consistent and regular execution of your own exercises according to the instructions!
the osteopathic and manual therapeutic treatment of the overall statics, especially of the pelvic-leg chains.
a focused shock wave therapy of the changed tendon tissue, as well as a radial shock wave therapy of the rear leg muscles.
Initially intensive physical therapy measures in the form of laser therapy or high-energy magnetic field therapy
If the findings are severe, orthobiological injection therapy, e.g. using your own blood and/or hyluronic acid, ultrasound-guided sclerosis of the neovessels or high-volume tenolysis.
As a supporting measure , cold therapy and kinesiotaping
an individual insole fitting after carrying out a stance and gait analysis, as well as a 4D spine measurement .
supportive physiotherapy in the form of physiotherapy and manual therapy.

Depending on the findings, a night positioning splint, acupuncture or an Achilles tendon bandage may also be added.

Cortisone injections are an absolute taboo for us in the Achilles tendon area!

Further links, sources and literature references for the treatment of Achilles tendon pain - Achillodynia: