The Achilles tendon is the large tendon just above your heel that you can feel like a cord when you move your foot up and down. It’s the largest and strongest tendon in the body, and it’s prone to inflammation, giving a painful disorder called Achilles tendinopathy.
It’s not well understood why this tendinopathy occurs. One working theory is that micro-tears in the tendon accumulate from overuse, and in trying to repair, this results in pain and swelling, especially where the tendon attaches to the heel bone. Pain is often worst in the morning and improves through the day.
Pain may restrict you completely from exercising, but if you do manage to, you may find that pain is worst when you start, but gradually eases as you pursue your workout.
Achilles tendinopathy is more common over the age of 30 and in those who suddenly increase their exercise levels. Other contributors include obesity or a lack of strength or flexibility in your leg muscles.
Achilles tendinopathy gets better by itself with time and limiting activities that bring on pain. Only a small proportion of people with Achilles tendinopathy require any formal treatment from a doctor or physiotherapist for continued pain. However, tendons are slow to heal and it may take several weeks or months for complete improvement.
Activities that cause your heel pain should be avoided where possible. This may require altering your exercise or recreational activities and a discussion with your employers to amend certain duties. High impact activities such as running should be limited and a slow, graded return to these activities is vital when your symptoms start to improve. It is also important to ensure that you are wearing footwear with appropriate cushioning.
Your symptoms may benefit from applying a cold compress or ice pack to the affected area during painful episodes. Painkiller medications can provide some relief, the most effective of which are anti-inflammatory gels or creams applied to the skin.
The best way of permanently resolving your Achilles tendinopathy is the use of specialised stretching and strengthening exercises, though this can take several months to see significant improvement.
For pain relief of Achilles tendonopathy, a good start is paracetamol. You can take one or two tablets up to four times a day (leave four to six hours between doses). Paracetamol is generally well-tolerated and safe for most, except those with liver disease.
Addition of an anti-inflammatory such as ibuprofen may help bring down any swelling of the soft tissues around the Achilles tendon and provide additional pain relief. You can take 200mg to 400mg up to three times a day regularly for a few days.
Ibuprofen is known to cause irritation to the stomach lining, so it's best to take it with food. You should speak to your doctor or pharmacist before taking ibuprofen if you are taking any other medicines, particularly blood pressure or stroke prevention medicines, if you've previously had gastric ulcers, if you have kidney disease or you are pregnant.
Anti-inflammatory gels such as Voltarol gel (contains diclofenac) or Deep Heat (contains an aspirin derivative) provide alternatives and are more appropriate for long-term use.
For more severe pain, codeine-containing combinations can be helpful. Co-codamol contains codeine and paracetamol, Nurofen-Plus contains codeine with ibuprofen. You should avoid taking paracetamol, ibuprofen or aspirin alongside these, to avoid double-dosing.
Ankle supports with braces can help to provide stability and comfort around the Achilles tendon and may prevent further injury.
If in doubt about the suitability of any medicines for you specifically, please speak to your local pharmacist or doctor.
For most people Achilles tendinopathy can be self-managed with the above strategies. Most important is a period of rest and avoidance of activities that cause pain: this may require adjusting your normal exercise routine.
Where your symptoms are causing significant limitations or have failed to improve after these simple measures, you should make an appointment with your doctor. Your doctor may advise you on further options for painkillers, exercises or they may refer you to a physiotherapist.
Very occasionally if your symptoms are severe or longstanding your doctor may refer you to a specialist where further treatment options can be considered including shockwave therapy or, as a last resort, surgery.
You are fit for work if you have Achilles tendinopathy. However, if the nature of your work puts further stress on your heel, you could negotiate amended duties with your employer until you have recovered.
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