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Is Achilles heel Edinburgh's only weakness? | Find Your Stride

Updated: Mar 16, 2023

Achilles tendinopathy is an injury I’ve seen on numerous occasions. However, since opening an Edinburgh foot clinic I’ve seen this injury even more! I’ve asked myself; are the people in Edinburgh more active? Are they spending more time climbing Munro’s? Or is it just the never ending hills this city has to offer? I’ll probably need to conduct some research to confirm whether all Edinburgh podiatry clinics are inundated with achilles injuries, but until then I thought a blog post might help a few readers to understand their injury a little better.

What is it?

Achilles injuries are common, they occur when the large tendon running down the back of the lower leg (between the knee and heel bone - see below) becomes irritated or inflamed. The Achilles tendon is the largest in the body, we use it constantly when walking, running, climbing stairs, jumping, or standing on tip toes and although it is usually very strong the tendon is also prone to injury (usually caused by overuse). Typically, Achilles injury can be categorised as either mid-section (in the middle of the tendon) or insertional (at the bone, where the tendon ‘inserts’ on your foot).

Injuries at the Achilles tendon (as with other tendon injury) are often called a tendinitis or tendinosis. Tendinitis describes an acute inflammation of a tendon. Although inflammation is normal (it is our body responding to injury), it causes swelling, pain and sometimes redness, which are obviously uncomfortable and can cause significant distress. Tendinosis on the other hand describes a microscopic degeneration of the tendon (seen as thickening), as a result of chronic damage over time. It is possible to have both of these at once and it isn’t always possible to diagnose one or the other. Therefore, I usually opt for the term Tendinopathy which describes any problem with a tendon (the suffix ‘pathy’ is derived from Greek and indicates a disease or disorder) because an obvious tendinosis could still be inflammed and present like a tendinitis. In fact, for the rest of this post I’m going to use Achilles tendinopathy when referring to achilles injury.

Lastly, I must mention Achilles tendon rupture, which is very different from Achilles tendinopathy. Rupture (as the name suggests) involves a separation (breaking from the bone or complete tear) of the tendon. This typically results from a sudden injury, so you’d usually know if this has happened (it’s difficult to miss), as there is usually an audible pop, significant pain and a lump at the bottom of your calf muscle, where the tendon has bunched up.

Some interesting facts:

  1. Achilles tendinopathy It is the most frequently reported overuse injury

  2. It is more likely to occur as we get older (most likely between 30-50)

  3. Prevalence is 1.85 per 100 patients (De Jonge et al. 2011)

Why does it happen?

Achilles tendinopathy is not always related to a specific injury, instead repetitive stress applied to the tendon without sufficient rest is usually the culprit. Other factors can also make a person more likely to develop Achilles injury, such as:

  • A sudden increase in the amount or intensity of exercise activity i.e. marathon training

  • Tight calf muscles. Calf muscle tightness puts extra stress on the Achilles tendon, especially where it inserts into the heel bone.

  • Retrocalcaneal exostosis (a bony lump on the back of the heel). This causes an enlargement of the bone on the back of the heel, which can rub on the Achilles tendon causing inflammation and pain.

What are the symptoms?

Common symptoms of Achilles tendinopathy include:

  • Pain and stiffness along the Achilles tendon in the morning

  • Pain along the tendon or back of the heel that worsens with activity

  • Severe pain the day after exercising

  • Thickening of the tendon

  • Formation of a bony lump on your heel (insertional tendinopathy)

  • Swelling that is present all the time and gets worse throughout the day or with activity

  • Pain on the back of the heal when you wear shoes

So, if this sounds familiar it's usually best to contact a podiatrist or physiotherapist for some guidance. Fortunately, Edinburgh podiatrists are probably seeing a lot of achilles problems, meaning we are well placed to help. At Find Your Stride we offer free telephone consultations so don't hesitate to get in touch if you're concerned. Our experienced podiatrists at the Edinburgh foot clinic would be more that happy to help.

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