Why Achilles Tendon Problems don’t Heal.

You wake up in the morning and as you put your feet to the floor and take your weight there it is again that deep ache in your left Achilles area. All you know is that after a few steps it gets a little easier. By the time you reach the bathroom the deep ache is subsiding. Negotiating the stairs you find it easier to place your weight on your left heel. You can go up on your toes but it aches slightly more. Determined to go for a run and see your friends you arrive at training feeling not too bad. Spending time warming up it’s not aching as much. It’s only a 3K. Others are telling you not to run. Assuring them you’re all right, you’re off. Within 100 meters there it is again and you slow to a stop utterly frustrated. Familiar.

The Achilles Tendon

The Achilles tendon is the thickest tendon in the body. It’s a continuation of the gastrocnemius and soleus muscles. At the lower end they are part of the heel (calcaneus) at the calcaneus tuberosity. Covering the tendon, and here’s the important bit, is fascia (a body wide supportive tissue) and the integumentary system (protects the tendon from dehydration and damage from the outside). So, we have the tendon and the covering tissues.

Blood Supply

Here’s what I have found over thirty-five years of clinical practice. You can have scans that may show minor inflammation of the tendon covering. Perhaps there is some minor degeneration. Generally, this isn’t the issue. Blood (vascular) supply is the issue. After a long sleep or when ever you’re off your feet the blood supply to that area decreases, relative to the surrounding tissue, due to lack of physical movement. That’s why it aches first thing in the morning. As you hobble to the bathroom you pump blood through. When you attempt the 3K run the tendon demands more blood but you can’t deliver and the pain returns.

In a strange quirk of nature, only She knows why,

1. the top and bottom of the tendon are supplied by posterior tibial artery but
2. the middle is supplied by the peroneal artery.

This middle section is poorly supplied. When you over train and/or you’re overweight for the type of training performed this area takes most of the load. You feel the area is weak.

Nerve Supply

We tend to get things the wrong way up. Behind the hip is the ‘bottom’ there’s a reason for this. It’s the base of the whole leg not the foot as your leg grows from your hip down not the floor up. The pelvis blades spread force out as your feet hit the floor in running. If the hip area gets tight the force is sent straight back downward and the Achilles tendon takes on too much load.

The tibial nerve is a branch of the sciatic nerve (low back) and travels behind the knee to the Achilles tendon and blood vessels. At the root of the sciatic nerve, from the 3-4^th lumbar to the 2^nd sacral region, is the root of all the problems. As the sciatic nerve leaves the spine it has to pass between the aforementioned vertebral levels. Any upset in this region irritates the sciatic nerve which is renamed the tibial nerve as it travels down the leg.

Tendon Inflammation

Further trouble black spots are the muscles at the back of the hip. These two areas, amongst others, can irritate the tibial nerve and lower down the Achilles tendon becomes weakened due to disturbance of the blood supply.   The fine branches of the peroneal arteries open up and leak stuff due to poor nerve supply. This stuff causes a shift towards:

1. acid fluid,
2. thickens the local tissue,
3. increases local pressure and
4. this is what is called inflammation.

Bingo, here’s your problem.

Find the Source

To sort out the problem somebody has to find the source of the irritation higher up. I’ve done it hundreds of times and it ALWAYS works, if that’s the cause of the problem!! X-rays, scans etc etc of the low back area may or may not reveal the problem. You can exercise, wear a walking cast, neoprene support and even have a steroid injection.  All will be symptomatically effective for a few weeks or months, but in the long term the source of the problem is still there. If it’s not addressed then you are only storing up trouble. The weakness can continue deeper to the tendon with consequences that aren’t worth thinking about.

Find somebody to seek the source of the problem. It’s all in the diagnosis not the treatment.

Hope this helps. Any questions about any topic please leave messages and I’ll get on to it.

Happy running!

Walter has over 35 years clinical experience in osteopathic sports medicine. Covering areas as philosophy, psychology, trauma, & coaching. Sports covered include running, American football, rugby (both codes) and tennis. He is an international lecturer and author.

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Disclaimer: There is no substitute for a qualified and experienced health care professional. Asking on social media, your mates, and your mum or dad (unless they are health care professionals) only leads to confusion.