Behind the Knee
Achilles Tendinopathy
The Achilles tendon is a thick, fibrous cord that connects your calf muscles to your heel bone and functions like a spring to store and release energy during walking, running and jumping activities. The tendon has the capacity to handle a significant amount of load due to its spring-like properties.
During running the tendon accepts seven times your body weight with each step. However, even though it is the strongest tendon in the body, it has the potential to become injured if it is repeatedly exposed to loads greater than your usual capacity – this could be the result of starting a new gym program, taking up a new activity or due to reducing muscle strength or joint motion which places more load on the tendon.
What are the symptoms of Achilles Tendinopathy?
Achilles tendinopathy typically produces pain in the back of the leg, approximately 2-6cm above the heel bone. It will usually occurs when you exercise and eases when you rest. As the condition worsens, you may begin to experience pain during activity and at rest, or during activities of general life that were once pain-free.
How is Achilles Tendinopathy treated?
Your treatment will be focused on managing the factors that caused you to develop Achilles tendinopathy. Initially, manual therapy techniques and load management will be utilised to relieve your initial symptoms. As your symptoms begin to settle we can then work with you to improve any deficits in muscle strength or joint motion.
A key factor in treating your painful Achilles tendon is that it will not respond well to rest. However, as tendons are good at absorbing load, they respond well to progressive strengthening exercises. The main goal here is to build strength in the tendon and muscles so that they can better tolerate the load of your daily activity.
It is really important to address any Achilles tendon symptoms early on, as this reduces treatment time and gets you back to doing what you love, sooner.
What else could it be?
- Haglund’s deformity
- Retrocalcaneal bursitis
- Partial or total rupture of the Achilles
Lateral Ankle Sprain
An ankle sprain occurs when your ankle rolls or twists beyond its normal range, which can result in stretching or damage to the ligaments that stabilise your ankle. The most common ankle sprains will affect the ligaments on the outside of your ankle.
Unfortunately up to 40% of people who suffer ankle sprains can go on to develop chronic ankle instability.
The good news is that with the proper treatment you can help to repair and re-stabilise your ankle, allowing you to return to your chosen activity and reducing your risk of future complications.
What are the symptoms of a Lateral Ankle Sprain?
The severity of your ankle sprain will determine the symptoms you experience. Immediately after an ankle sprain, you may have some swelling, bruising or tenderness in the area.
Once the initial symptoms have settled, you may be left with some lingering swelling, a stiff feeling in the ankle with reduced motion, a sense of reduced balance or instability or a combination of these symptoms.
How is a Lateral Ankle Sprain treated?
The initial goal for your recovery is reducing the swelling around your ankle, to help you regain normal motion and reduce pain.
Then we need to ensure you are able to get back to your normal daily activity or sport by focussing on balance and proprioception, as well as building strength around the ankle.
What else could it be?
- Fracture
- Chronic ankle instability
- Peroneal tendinopathy
- Syndesmosis injury
- Ankle impingement
Peroneal Tendinopathy
The peroneal tendons connect the peroneal muscles to the bones of your foot and help with maintaining your balance. One tendon (peroneus brevis) attaches at the base of the fifth toe, while the other tendon (peroneus longus) attaches to the sole of the foot, inside of the arch.
Either of these two tendons can develop tendinopathy if there is an increase in your load which places excessive strain on the tendons.
What are the symptoms of Peroneal Tendinopathy
The symptoms of Peroneal Tendinopathy may come on suddenly, however, in some cases they will develop slowly over time. You will typically experience pain in the back and outer aspects of your ankle. The pain you experience will worsen with activity and reduce once you rest.
How is Peroneal Tendinopathy treated?
Your treatment will initially focus on reducing any pain or swelling that is present through the use of manual therapy techniques and load management.
As your symptoms begin to settle, we will then work with you to increase the load tolerance of your tendon through the use of progressive strengthening exercises – this will help you to be able to tolerate loads of your daily activity and sport to prevent re-injuring your tendon.
What else could it be?
- Ankle sprain
- Fracture
- Cuboid syndrome
- Chronic ankle instability
Posterior Tibial Tendinopathy
The tibialis posterior muscle is located behind your calf muscle and attaches directly to the back of your shin. The tendon of this muscle works like a spring to store and return energy when you are walking and running.
However, it can become overloaded due to a rapid increase in your training load, reduced muscle strength or as your shoes become worn, which places greater strain on the tendon. This can lead to the development of inflammation around the tendon, which can progress to Tendinopathy.
What are the symptoms of Posterior Tibial Tendinopathy
The symptoms of Posterior Tibial Tendinopathy will occur with activity and reduce when you rest. You will typically experience pain on the inside of your ankle just below the bone, and over time your pain may progress to the outside of your ankle.
Your symptoms can be exacerbated when walking or running on uneven surfaces. In addition to the pain, you may notice a lowering of your arch on the affected side and may even struggle to turn your foot inwards.
How is Posterior Tibial Tendinopathy treated?
Your treatment will initially focus on reducing the strain on the tendon to allow healing to occur and reduce the risk of your injury progressing to an adult-acquired flat foot. Your initial treatment may encompass treatments such as taping, activity modification or orthoses depending on the severity of your tendinopathy.
As your symptoms begin to settle, we will work with you to improve your muscle and tendon tolerance to load through a progressive strengthening exercise program.
What else could it be?
- Tarsal tunnel syndrome
- Adult acquired flatfoot
- Medial ankle sprain
- Plantar fasciopathy
- Achilles tendinopathy
Medial Tibial Stress Syndrome (shin splints)
Medial tibial stress syndrome is an overuse injury that affects your shin and the surrounding muscles. The condition is commonly seen in those who perform running or jumping activities and occurs 4-6 times more often than Achilles and plantar fasciopathy in runners.
It can arise due to increases in training volume or alterations in your joint motion or muscle strength. If left untreated, you may have to reduce or even stop performing your beloved activities, and in severe cases, your symptoms can even progress to a stress fracture.
What are the symptoms of Medial Tibial Stress syndrome?
Medial tibial stress syndrome presents as pain along the lower two-thirds of your inner shin. The pain will usually occur after you have performed high-load activities such as running or jumping, and linger long after you stop.
As the condition progresses, your pain will begin to come on sooner into activity and may even present when walking.
How is Medial Tibial Stress Syndrome treated?
Initially, your treatment will focus on relieving your symptoms, however, the most important aspect of treating your shin pain is determining the underlying cause. To reduce your risk of future symptoms, we will look into your training volume before your shin pain started, and then work with you to reduce any other factors that have contributed to the development of your shin pain through a progressive strengthening program.
What else could it be?
- Biomechanical overload
- Tibial stress fracture
- Posterior tibial tendinopathy
we treat whatever life throws at you.
Use the interactive foot model to help identify your concern:
