Achilles tendon problems in runners
Achilles tendon complaints are a common problem in people who are active in sports such as running, jumping or other high-impact activities. The Achilles tendon is the largest and strongest tendon in the human body and plays an important role in our movement pattern. This tendon connects the large calf muscles, the gastrocnemius muscle and soleus muscle, to the heel bone (os calcaneus) and acts as an important link in the transfer of power from the legs to the foot.
With a lot of the same movement or long-term overuse of the Achilles tendon, damage to the tendon tissue can occur. This can range from minor damage (microtrauma) to reduced elasticity and hypersensitivity in the area around the tendon.
The Achilles tendon is particularly susceptible to overuse due to its central role in the musculoskeletal system. Factors such as a sudden increase in training intensity, insufficient recovery, poor footwear or incorrect running technique can contribute to the development of symptoms. Moreover, reduced mobility of surrounding structures such as the ankle and foot can cause additional pressure on the Achilles tendon.
Achilles tendon problems have a significant impact on daily life. Activities such as walking, climbing stairs or playing sports can become painful or even impossible. It is important to recognise symptoms early and start the right treatment. Targeted interventions such as exercise therapy, mobilisation and improving muscle strength and coordination can speed up the recovery process and reduce the risk of recurrence.

Causes of an Achilles tendon injury
One of the key concepts in the development of an Achilles tendon injury is the balance between load and load capacity. The Achilles tendon is designed to absorb and transmit large forces. As long as the load on the tendon is proportional to its load capacity - or the capacity of the tendon to handle those forces - the tendon remains healthy. When this balance is disrupted, it can lead to symptoms and eventually an injury.
Load refers to the forces acting on the Achilles tendon during activities. Sports such as running, tennis and football involve high forces due to the explosive movements, jumps and abrupt stops. In particular, a sudden increase in load - such as running more kilometres, training more intensively or exercising on a hard surface - can overload the Achilles tendon. This leads to negative adjustments in the tendon tissue, which normally heal again with sufficient recovery.
However, when the load is consistently too high or too little time is taken for recovery, these small lesions can accumulate. This process can eventually result in tendon degeneration, reduced elasticity and symptoms such as pain, stiffness and swelling.
Risk factors
Age: From the age of 30, the elasticity of the Achilles tendon decreases, making it more susceptible to overuse. This risk is higher in athletes over 40, especially after a period of inactivity.
High-impact sports: Intensive sports such as running, tennis and football put a lot of pressure on the tendon due to explosive movements and jumps. Insufficient recovery increases the risk.
Previous injuries: an old injury is often less strong and flexible, increasing the risk of recurrence. Incomplete recovery further increases this risk.
Complaints and symptoms
Diagnosis and examination of Achilles tendon pain
Diagnosing Achilles tendon pain starts with a comprehensive intake and physical examination. At Fysio Fitaal, we take the time to carefully assess the symptoms and identify the cause. Diagnosis focuses on identifying specific symptoms, such as pain, stiffness, swelling or a thickening of the tendon, and determining the severity and stage of the complaint.
Physical examination
During the physical examination, we assess various factors contributing to the symptoms:
- Pain and swelling: By palpating (feeling) the tendon, we check for pain points, swelling and any thickening.
- Mobility and flexibility: We test the range of motion (ROM) of the ankle and the tension in the calf muscles. Limited mobility may indicate increased strain on the tendon.
- Muscle power: Calf muscle strength is assessed, often through strength exercises such as a one-legged heel lift. Reduced strength or asymmetry between the legs can contribute to Achilles tendon strain.
- Gait analysis: By observing gait and foot settlement, abnormalities in biomechanics can be identified
The role of ultrasound
At Physio Fitaal, we use ultrasound as an essential part of the diagnosis of Achilles tendon pain. Ultrasound is a safe and painless imaging technique that allows us to get a detailed image of the tendon and surrounding structures.
With ultrasound we can:
- Tendon tissue assessment: We can detect changes in tendon tissue, such as thickening, degenerations or small tears.
- Seeing inflammation and swelling: Ultrasound makes it possible to pinpoint inflammation or fluid accumulation around the tendon.
- Determining the severity of the injury: By accurately imaging the structure of the tendon, we can distinguish between mild irritation, tendinopathy or more serious damage such as a partial tear.
- Monitoring treatment progress: During the recovery process, we use ultrasound to evaluate progress and monitor the effectiveness of treatment.
Ultrasound provides valuable information that helps to design targeted and effective treatment. It makes it possible to address not only the symptoms, but also the underlying causes of the symptoms.
Treatments and prognosis
At Fysio Fitaal, we believe in an active and personalised approach to treating Achilles tendon pain. Our aim is not only to relieve your pain, but also to help you return stronger and minimise the risk of future injuries. In doing so, we always take into account your specific goals and wishes, so that treatment is fully compatible with your lifestyle and activities.
At the heart of our treatment is an active approach. This means we encourage you to keep moving within your pain limits. Rest is important in the acute phase, but complete inactivity can actually weaken the tendon. Therefore, we focus on controlled and progressive loading of the Achilles tendon.
We start with targeted exercises that improve calf muscle and tendon strength and flexibility. Eccentric exercises, where the muscle slowly lengthens during load, have been proven effective in the recovery of Achilles tendon problems.
An important part of treatment is careful load building, also known as load management. This means that we gradually increase the load on the tendon, depending on your recovery and load capacity. We guide you step by step in this process, so that you can move safely and confidently again.
Treating on time
If the irritated Achilles tendon is not treated in time, it can lead to Achilles tendinosis, which can become a chronic inflammatory condition. Over time, this can lead in a deterioration of Achilles tendon tissue, which in turn can lead to tears in this tissue, which in turn can lead to a rupture (source: J.Metzl, M.D.).
With Achilles tendon pain, it is advisable to have it examined/checked by a physiotherapist and or GP. Some doctors like Mr Metzl, suggest, that an ice bath 15-20 minutes a day can reduce swelling in the Achilles tendon region. Sometimes medication such as ibuprofen or anti-inflammatory cream can have a relieving effect (temporarily).
Are you looking for professional sports physiotherapy? Then send an e-mail to info@fysiofitaal.nl or get in touch via en contact form.
Making an appointment at FysioFitaal
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