Do you get stiff, sore heels in the morning? Do you suffer from heel pain after exercise? Photo by Cpl Damian Shovell, Army newspaper

The weak spot in Achilles

By Geoffrey Crowley
Stiff sore heels in the morning? "...but it goes away after I limp around for 10 minutes..." or worse "... but it warms up with exercise and doesn't hurt until I cool down...".

If this applies to you, read on; you may be suffering from a tendon problem.

It's important that you seek some advice and address this problem immediately otherwise things can worsen.

Untreated, you may reach the stage where the pain doesn't resolve after your warm up, but stays for the duration of your exercise, or worse again, the soreness may be constant throughout the day. If it reaches this stage the condition can be debilitating and difficult to treat.

A common diagnosis for many different presentations of heel pain is tendonitis. There are many myths and misconceptions about the conditions commonly referred to as tendonitis.

The term is often applied to cases of inflammation of the tendon sheath (paratendonitis), damage to the tendon (tendinopathy) or inflammation at the site where the tendon joins onto the heel bone (insertional tendonitis or bursitis).

It is essential to obtain a specific diagnosis to establish which of these conditions is present, as the methods of treatment vary greatly for each.

The term tendonitis literally means inflammation of the tendon. In many cases of heel pain located about 3cm above the heel bone, there is no inflammation present when the tendon is scanned or viewed by microscopic analysis.

Therefore the true term that should be used for this particular problem is Tendinopathy, meaning tendon problem.

In these instances of non-inflammatory conditions, rehabilitation is more aggressive. A specific program of exercise is prescribed by a physiotherapist and performed under the guidance of a PTI.

This may begin with light exercise for the calf muscle and tendon and progress to heavier weights. Contrary to common beliefs, stretching of the affected tendon may be of little benefit. Anti-inflammatory medication or injections are usually of no help for this condition.

In the case of bursitis or paratendonitis, initial treatment needs to be more conservative, including rest from aggravating activities, ice and correction of training errors.

As these conditions are inflammatory in nature anti-inflammatory medication and occasionally cortisone injections can assist the recovery process.

Orthotics (inserts in your footwear) are beneficial under some circumstances as they can reduce adverse load on the tendon.

Specific exercises are prescribed by the physiotherapist as the inflammation subsides and are gradually progressed as the condition improves.

The healing process for tendons is slow and perseverance with the advice and exercises is essential for success. Often six to 12 months of rehabilitation are required. If this regime fails to alleviate the problem, surgery is occasionally attempted. Around 60 per cent of patients achieve a good outcome with surgery, after a further six months of rehabilitation. Surgery is considered to be a last resort.

Your "Achilles heel" may be your weak link as is so often implied, but with correct advise and exercises, and a bit of perseverance you could be rid of your morning stiffness for good.

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