Pain and its causes: Achilles tendonitis

Pain in the Achilles tendon (med. Achillodynia) usually indicates an Achilles tendonitis, a bursitis in the upper heel bone or an Achilles tendon irritation. In rare cases, an Achilles tendon tear is also present.

However, foot pain is usually not serious and can usually be treated well with the right home remedies, self-help exercises and treatment tips. Medical editor Krystian Manthey gives a comprehensive overview and shows you what you can do.

Diagnosis: Correctly interpreting symptoms of Achilles tendon pain

The Achilles tendon connects your calf muscles to your heel and is used to transmit power when running. Although it is the strongest tendon in the body, it also forms its literal foundation and is therefore exposed to high loads - which it can usually handle very well.

A wide variety of risk factors can still lead to incorrect and overuse damage and pain in the Achilles tendon - usually a few centimeters above the heel bone, since the tendon is least supplied with blood vessels here.

The pain is usually unilateral or at least stronger on one side. The reason for this is that the preferred leg is subjected to more stress in everyday life.

symptoms

• Formation of calluses on the heel
• The Achilles tendon is noticeably thickened, swollen, or reddened
• Pain when pressure is applied to the Achilles tendon

The development of Achilles tendon pain can be divided into three stages:

1. The Achilles tendon hurts depending on the load and only during movements that stretch the tendon, for example when climbing stairs, jogging or running uphill. This is usually an irritation of the Achilles tendon (med. tendopathy) due to the smallest micro tears in the tendon. Achilles tendon pain goes away with rest.

2. The Achilles tendon is noticeably thicker and hurts more often without strain. These symptoms are characteristic of Achilles tendinitis . It is often the result of untreated irritation of the Achilles tendon. Pressure pain is clearly diagnosable.

3. If the heel pain is permanent, it is referred to as chronic inflammation of the Achilles tendon.

Another possible consequence could be a tear (rupture or partial rupture) of the Achilles tendon . The collagen bundles of the Achilles tendon can break down and tear more easily as a result of permanent incorrect or excessive strain and lack of exercise. Such an Achilles tendon rupture can also occur independently of the previous stages.

To diagnose Achilles tendon pain, your orthopaedist, general practitioner or sports doctor can scan your Achilles tendon. If the area is very painful, it is usually an Achilles tendonitis. A clear thickening, small "bumps" or a crunch are due to fiber deposits and can already indicate chronic achillodynia.

In addition, the Achilles tendon can be examined by X-ray or ultrasound. However, this is usually not necessary, since this rarely results in added value for the therapy. X-rays can also have a mutagenic effect. X-ray examinations should therefore be reduced to a necessary minimum in your own interest.

Pain in the Achilles tendon can also be caused by bursitis at the base of the heel or by a so-called Haglund's heel . However, the treatment looks very similar in all cases.

Achilles tendonitis pain: causes and risk factors

Pain in the Achilles tendon occurs when small tears develop in the tendon (=Achilles tendon strain) and the surrounding fascia. This causes minor injuries and microscopic bleeding, which ultimately triggers Achilles tendonitis (inflammation) and leads to the typical heel pain.

The main reasons for this are long-term incorrect or excessive strain - especially in running and jumping sports with high strain or quick changes of direction such as football, tennis or long-distance running. Additional damaging factors are: obesity , unsuitable shoes , unfamiliar (training) loads , foot malpositions , lack of exercise and excessive sitting .

“Lack of exercise and sitting” , you may be asking yourself? Quite right! Because your Achilles tendon is the link between your calf muscles and the heel and transfers the kinetic energy to the skeleton of the foot when you run.

However, if your muscles, fascia and ligaments in the calf and Achilles tendon area are shortened and tense, there is increased traction with every step, which can ultimately lead to inflammation. In addition, you favor the emergence of a Haglund's heel . Because your body tries to reduce this pull by forming a bony extension at the base of the Achilles tendon.

Why do the Achilles tendon and calf shorten?

Since the beginning of human history, we have had to travel many kilometers every day to get food. Our ancestors almost always went barefoot. The most diverse surfaces stretched and strengthened the feet in many different ways.

As modern screen workers, however, most of us rarely cover more than two kilometers a day - and often in the same shoes and over level and less demanding floors. Our body, which has been evolutionarily trimmed to adapt, breaks down unnecessary structures and causes muscles and connective tissue to shorten.

Risk factors for the development of pain and inflammation in the Achilles tendon at a glance:

Unfavorable sleeping position: Do you like to sleep on your stomach? Unfortunately, if you have Achilles tendon pain, this is counterproductive. Because lying on your stomach, your feet are almost inevitably hyperextended. As a result, the calf and Achilles tendon shorten and you promote an inflamed Achilles tendon.

Lack of exercise : Over millions of years, our body has adapted to a wide range of movement. Excessive sitting, sometimes up to 12 hours a day, causes muscles, fascia and ligaments to harden and shorten. The World Health Organization therefore recommends walking around 10,000 steps (approx. 7 km) every day.

Lack of barefoot walking: The little time that the average German walks a day is mostly on level ground and only rarely barefoot. The muscles and fascia of the feet are understrained and literally atrophy. The frequent result is foot malpositions. Just like the rest of your body, your feet need a variety of movements. If walking barefoot is difficult for you in everyday life, modern barefoot shoes, foot gymnastics, foot massages or standing on an acupressure mat can also promote your foot health.

Wrong footwear : Poorly fitting shoes or those with hard heel material irritate the back of the heel when walking and thus promote bursitis in the Achilles tendon. Many shoes and insoles also have a heel lift or arch support: however, the raised heels shorten the calf muscles; and the artificially created foot arch relieves your foot of the work you have to do to hold your foot and promotes foot malpositions.

Foot malpositions: Achilles tendonitis can occur in particular as a result of a flat foot or a flat foot (inward inclination) and a hollow foot (outward inclination). Because these foot malpositions change the inclination of your foot axis and thus lengthen the path of the fascia and ligaments. This increased tension can then lead to pain in the Achilles tendon.

Overload: If you are "forced" to run a lot at work or if you do an intensive type of running, this can promote Achilles tendon pain. In particular, unfamiliar or sudden stress quickly leads to inflammation. With the right footwear and well-trained feet, however, high loads are also possible without any problems.

Overweight: A high body weight in combination with other risk factors increases the load with every step and promotes foot deformities and inflammation.

Pelvic obliquity and leg length discrepancy: Both increase the one-sided load on a leg, which can lead to overuse damage and inflammation.

Metabolic disorders such as diabetes, arthritis or gout can also lead to inflamed Achilles tendons in rare cases.

Treatment of Achilles tendon pain: helpful exercises and therapy measures

You can treat an acute, very painful Achilles tendonitis according to the PECH rule:

Pause : Pause the pain-causing strain.

Ice : Cool the Achilles tendon. This reduces swelling and pain.

C ompression: A compression bandage slows the spread of swelling. You can combine this with painkilling home remedies and ointments such as arnica, castor oil, capsaicin or quark wraps.

Elevation : Elevate your leg, ideally at heart level, to improve blood flow.

You can reduce the pain in everyday life by walking barefoot more often or by wearing heel-free shoes such as flip-flops. Thicker socks or a bandage can also reduce heel friction.

The previous measures all reduce the symptoms, but not the root causes. These are primarily unsuitable shoes and muscular-fascial imbalances between the foot-raising and foot-lowering muscles. If you want to permanently get rid of the pain in the Achilles tendon, you have to tackle these problems:

Compensating for muscular imbalances : Strengthen your shin muscles and stretch your calves and Achilles tendons. You can find exercises for this below.

Eliminate foot misalignments and walk barefoot more often : Correct the inclination of your foot axes and regularly walk barefoot on a wide variety of floors. Also switch to barefoot shoes (also called minimal shoes) without raised heels. Video

Self-healing and strengthening metabolism : Foot massages, alternate foot baths and standing on an acupressure mat stimulate the blood circulation in your feet.

The classic therapy usually recommends pain medication and shoe inserts against the Achilles tendon pain. Both can probably relieve the pain temporarily. However, the insole also shortens the calf muscles, which in turn further increases the load on the Achilles tendon. Painkillers and injections merely numb the pain without addressing the cause. As a result, there is a risk that harmful behavior will go unnoticed and thus worsen the Achilles tendonitis. In addition, with every drug and operation there is a risk of side effects. Therefore, all conservative options should be exhausted beforehand.

Exercises for Achilles tendon pain

In order to treat the cause of your Achilles tendonitis, you need to correct the muscular imbalances in your feet and calves. The following self-help exercises aim to do just that.

Improvement will probably not occur immediately. As the inflammation has developed almost imperceptibly over months or years, you should also bring patience, consistency and perseverance to the therapy. If in doubt, discuss the exercises with a therapist or doctor.

Exercise #1: "Stair Step Stretch"

Stand with the balls of your feet on a step. Alternatively, you can also use two books of the same size or something similar as a base. Then raise your heels and hold the position for about two seconds. Then slowly lower your heels back down into relaxation and stretching. Repeat the exercise 15 times. According to a study, pain was reduced by 44 percent after 12 weeks.

Exercise #2: Loosen calves with the foam roller

"Working" on your calf with the fascia roller is similar to a relaxing massage and stimulates blood circulation and lymphatic flow. This reduces the tension on your Achilles tendon.

To do this, place the calf of the affected side on the fascia roller and gently roll from the foot towards the back of the knee. You can adjust the massage pressure to a strength that you can bear by shifting your weight.

Exercise #3: Achilles tendon and calf stretch on the wall

Find a wall and stand in a lunge position at a distance of one to two meters. Now lean your hands or forearms against the wall. Try to actively pull your feet towards your shins.

If the stretching in the back leg is too weak, you can either push your pelvis further forward, bend the back leg slightly or increase the distance to the wall.

Important: The back heel should touch the ground. You should stay in the position for about two minutes on each side and gradually increase the stretch if necessary.

Correct foot deformities

Bent feet, flat feet and flat feet as well as hollow feet lead to a tilt of your foot axis. As a result, the stress on your joints and especially on your Achilles tendon is excessive and promotes inflammation.

The reason for most foot malpositions are muscular imbalances and tension in the foot and calf area. The main reasons for this are - in addition to a lack of exercise - "conventional shoes", which often have integrated arch support and thus relieve your feet of any holding work and freedom of movement. The raised toe base and raised heel also promote foot malpositions.

For this reason, I recommend going barefoot more often and switching to so-called barefoot shoes. Many providers have a very modern and chic design. However, there are a few things to keep in mind here. In this article you will learn more: "Is walking barefoot healthy? A look into human science and biomechanics”

With the exercise routine from the following video, you can train away your foot malpositions:

Stimulate self-healing and metabolism

The following tips are aimed at intensifying your metabolism and blood circulation in the Achilles tendon area and thereby strengthening your self-healing powers:

• Foot yoga (also called toega), foot gymnastics and foot massages
• Contrasting baths or showers for the feet
• Standing and walking on an acupressure mat as a foot reflexology massage
• A plant-based mixed diet and avoiding ready meals
• abstinence from drugs

His knowledge articles help hundreds of thousands of people seeking advice with evidence-based information to more well-being and happiness every month. With his newly published book " Wa(h)re Gesundheit: The health compass in the therapy jungle " with a foreword by Prof. Gerald Hüther, the author makes the essence and core findings of modern health research accessible in an aggregated and lay-friendly form.

reference

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