Lower Leg and Ankle

Lower Leg & Ankle

Shin Splints, Ankle Sprain, Calf Strain, Anterior Compartment Syndrome, Achilles Tendinopathy, Achilles tendon rupture, severs disease, peroneal tendonitis, subtalar joint pain, ankle joint pain, lateral ligament sprain, ankle instability, posterior tibial tendonitis, cramping calf.

Achilles Tendinopathy:
The Achilles tendon attaches the calf muscles in the posterior lower leg to the back of the heel (Calcaneus). There are two calf muscles, the Gastrocnemius and Soleus. These strong muscles allow us to rise up on our toes making them prime muscles used in walking and running.
Achilles tendon pain is usually due to small tears in the tendon which can develop over time. This may occur due to a single incident of overstretching or straining the tendon, or through general overuse where the tendon becomes worn and damaged.

Common causes include:

  • poor foot biomechanics, tight calf muscles, poor tensile strength through the tendon and calf muscles
  • overtraining
  • incorrect footwear.

Achilles symptoms include pain in the Achilles tendon, heel or lower calf. Tenderness to pressure and redness and swelling are common. There may be difficulty rising up onto your toes, particularly when standing on 1 leg only.

Early physiotherapy treatment for this problem is vital as it can become difficult to resolve the longer it has been there. Full rehabilitation is important to achieve an optimum outcome and prevent reoccurrence.

Physiotherapy treatment of Achilles tendinopathy may incorporate:

  • soft tissue release to tight calves
  • guidance on appropriate stretches and strengthening exercises including eccentric exercises if appropriate
  • advice on footwear and training.
  • Othotics to correct faulty foot biomechanics

In the past 10 years research new insights into tendon pathology has seen our understanding grow. The term tendonitis would imply that there is inflammation in the Achilles tendon. Through research into tendon pathology we now know that there is not always inflammation present. Recently most therapists have had to stop themselves from saying the old term of  €œtendonitis € and learn the new term  €œtendinopathy €. What a tendionpathy means is that there are structural changes taking place within the tendon.

Tendon injuries are usually the result of increased loads and overuse. This leads to changes within the tendon, which make it harder for it to cope. The injuries may occur in the mid-portion or, more commonly, in the insertion. At both sites the pathological changes of the tendon appear to be the same. Despite the common pathological changes within the tendon, different treatment approaches are used specific to the site of the problem, and this has been shown to have better outcomes.

This new research available to us provides much insight into why some patients have not responded to traditional treatment methods. It would appear that when an Achilles tendon is injured it goes through different phases in the injury process. These phases can be divided into:
 €¢ Reactive Tendinopathy
 €¢ Tendon Dysrepair (Failed Healing)
 €¢ Degenerative Tendinopathy
 €¢ Rupture/Tear
We know from ultrasound or MRI investigations that during each phase the tendon will have a very different appearance. It is therefore not appropriate to treat all Achilles tendinopathy patients with a blanket set of exercises. Calf stretches, heel dips and eccentric exercises will not always work for all patients. And now we have the research that tells us why.

At Wicklow Physiotherapy Clinic we will take a full history and this will give us a good insight into what stage your tendon is at and what we can do to help manage the problem. We also can refer you on for the appropriate investigation in order to assist in that correct diagnosis. The main aim of treatment is to provide you with the most effective treatment method to help alleviate this very painful and often debilitating condition.

Do not let this injury go untreated by your physiotherapist as it can become a chronic problem very easily. Contact us today at Wicklow Physiotherapy Clinic to book an appointment.

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