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Achilles tendinopathy

Written by Caidr's team of doctors and pharmacists based in UK | Updated: 21.02.2023 | 3 min read

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 is prone to inflammation, causing 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 worse in the morning and improves throughout the day.

Pain may restrict you completely from exercising, but if you do manage to, you may find that pain is worse when you start but gradually eases as you pursue your workout.

Achilles tendinopathy is more common over 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.

What's my prognosis?

Achilles tendinopathy improves with time and limiting activities that bring on the pain. Only a small proportion of people with Achilles tendinopathy require 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 discussing with your employer to amend certain duties. High-impact activities such as running should be limited, and a slow, gradual 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 nonsteroidal anti-inflammatory drugs (NSAIDs).

The best way of permanently resolving your Achilles tendinopathy is the use of specialized stretching and strengthening exercises, though this can take several months to see significant improvement.

Caidr pharmacists' top tips

For pain relief of Achilles tendinopathy, a good start is acetaminophen. You can take one or two tablets up to four times daily (leave four to six hours between doses). Acetaminophen is generally well-tolerated and safe for most, except those with liver disease.

Adding a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen or naproxen may help bring down any swelling of the soft tissues around the Achilles tendon and provide additional pain relief. You can take these medications up to three times a day regularly for a few days.

NSAIDs are known to irritate the stomach lining, so it's best to take them with food. You should speak to your doctor or pharmacist before taking them 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 if you are pregnant.

Topical pain rubs, such as Deep Heat or Bengay, provide alternatives and are more appropriate for long-term use.

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.

When should I see my 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.

If 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 and 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.

Am I fit for work?

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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