Pain and swelling in the back of the heel and calf muscles are often caused by a repetitive strain injury of the Achilles tendon. Tight calf muscles and faulty foot mechanics can predispose to micro trauma and degenerative changes within the tendon (tendinopathy), and/or inflammation (tendinitis), particularly in the area where the tendon inserts onto the calcaneum (heel bone).
Sporting activities such as sprinting or hurdling, can place an increased tension and load on the tendon, leading to a sudden rupture or tear. When the tendon completely ruptures (snaps), there is often an audible pop, resulting in severe pain, swelling and internal bleeding.
In the acute phase of injury, treatment will normally consist of RICE treatment (rest, ice, compression, elevation), immobilization and a course of anti- inflammatory medications. Physical therapy and rehabilitation should begin as soon as possible to encourage healing and a return to normal function .
(MRI scan showing a partial tear of the Achilles tendon, plus evidence of thickening and degeneration)
Before treatment commences, an accurate diagnosis should be made to differentiate between all potential causes of pain and dysfunction in the heel and calf. For example, a condition known as calcaneal bursitis can mimic symptoms of Achilles tendinitis. A specific diagnosis is also important to ensure treatment is administered in the correct way, targeting the appropriate soft tissue structure .
Some of the aims of treatment are to break down scar tissue, enhance tissue remodelling and to stimulate collagen fibre reorientation.
This can be achieved by applying a mechanical force to the tendon; cross fibre deep friction massage, ultrasound and extracorporeal shockwave therapy are the kind of modalities that can be used to achieve this. Specific exercises to load the tendon and eccentrically contract the calf muscles have also been shown to work effectively in the rehabilitation of Achilles tendon problems.
Surgical intervention is necessary in some cases to re- join a ruptured Achilles tendon.