Achilles tendinopathy
Understanding this condition
The Achilles tendon is the tendon that connects the calf muscles to the heel. It is the most powerful tendon in the body: it transmits the propulsive force with every step.
Achilles tendinopathy is a painful condition of this tendon. Two forms are distinguished: mid-portion tendinopathy (on the body of the tendon, approximately 4 cm above the heel, a less well-vascularised zone) and insertional tendinopathy (at the tendon's attachment to the heel bone). Causes are multiple: sports overuse, repeated microtraumas, inappropriate footwear, excess body weight.
Symptoms
Pain at the back of the heel or calf, typically in the morning ("start-up" pain with the first steps), which eases with warm-up and then returns at the end of exercise.
Over time, pain becomes constant, present even at rest. A lump or nodule may be felt on the tendon, sometimes tender. The tendon may be thickened.
How can it progress?
Without management, chronic tendinopathy weakens the tendon and increases the risk of rupture, particularly during a sudden effort or a misstep. Rupture is a surgical emergency in the majority of cases.
A neglected tendinopathy can also make sport impossible and limit daily walking.
Treatment options
First-line treatment is medical and prolonged: relative rest (but not total immobilisation), specific physiotherapy (stretching, eccentric calf work), insoles, analgesics. Shockwave therapy may be offered for certain forms.
When pain persists for more than 6 months despite well-conducted treatment, or in the case of rupture, surgery is considered. Several techniques exist (needling, suture, tendon transfer according to the case). A consultation guides the best option.