Pain when walking: Achilles Tendon pain explained

Pain in the back of the lower calf or heel or difficulty when walking could be Achilles tendon pain and needs immediate treatment

The Achilles Tendon and what it does

The Achilles tendon is the largest tendon in the body and it attaches the very powerful calf muscles to the heel bone (calcaneus) and lies at the back (Posterior) of your leg. There are three aspects to the Achilles of which any one section, or all three, can become painful. The tendon is split between its insertion portion and the peri/ paratendon, and there is also a bursa which is a small sac of fluid that lies between the bone and the tendon itself. This small sac of fluid serves to allow the tendon to glide friction free on the calcaneus bone. The Achilles tendon enables us to lift our heel which means its proper functioning is vital for us to walk and run, even for us to stand on the tips of our toes.

Stages of Achilles tendon pain

In its beginning stages Achilles tendon pain is quite often said to be tendonitis, which is an inflammation of the tendon due to repetitive micro trauma. When the bursa is involved this is referred to as Achilles bursitis. However when the issue has been present for a prolonged period it is often referred to as a tendonosis, which is a chronic condition denoted by degradation, weakening and misalignment of the tendon fibres during the repair phase. There may also be a bone spur present between the tendon and its bone insertion.

Causes of Achilles tendon pain

We are often asked as clinicians what is the main reason for an Achilles problem, but there is no quick answer to this question. Quite often there are several factors at play in the development of Achilles problems. Some of the main causes may be:

  • Tight calf muscles
  • Weak calf muscles
  • Ill-fitting or poor choice of footwear
  • Poor gait mechanics/ misalignment
  • Increase in running activities too quickly
  • Hill/ step running

There are many more factors, and patients may have a combination of multifactorial issues or could just have one issue.

It is very important to have an Achilles problem attended to, as the tendon issue can become chronic and lead to debilitating pain. Patients often have to stop sport due to pain and some patients find it difficult to continue in their daily work commitments. The biggest issue facing chronic tendon problems is the ability of the tendon to rupture and this can lead to surgical repair and a very lengthy rehab.

Remember, pain is the bodies’ way of saying there is a problem. So stop and fix the problem as it is often the people who ignore pain or push through the pain that can take the longest to repair. Unfortunately, there are no quick fixes in Achilles tendonopathy, as tendons and ligaments, unlike muscles have a low blood supply and can take a long time to heal. If you are experiencing any problems with your Achilles you should see a qualified podiatrist for diagnosis and treatment plan.

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