Gastocnemius muscle with Calcaneus tendon
Gastocnemius muscle with Calcaneus tendon

The Calcaneus Tendon – or as it is more commonly known Achilles tendon – attaches your calf muscles (gastrocnemius and soleus) to the calcaneus (heel bone). The Achilles tendon-gastrocnemius/soleus unit is involved in actions of the foot and ankle.

Tendons are dense connective tissue of collagen fibres that attach muscles to bones.  Their structure means that they have  a great tensile strength but have very limited elasticity and are not designed to stretch very much. They have very limited supply of blood vessels. Their structure, therefore, means that any injuries, such as ruptures, are likely to involve circumstances when they have been stretched beyond their limited range of movement. When the Achilles tendon ruptures there will be spasm in the gastrocnemius and soleus, accompanied by acute pain.

Achilles tendon ruptures can be caused by sudden change in activity that involve the ankle movements (particularly from inactivity to activity), excessive training and problems with the training surface and footwear. Other factors can include postural issues such as excessive pronation or muscle imbalance and stiffness in the gastrocnemius/soleus.  Age can also be a factor as the tendon starts to show signs of degeneration by the age of 25 years.

Achilles tendon ruptures cause intense pain (feeling as though you have been hit from behind) with walking becoming very difficult. It s possible to have a partial rupture which can become a more chronic condition leading to prolonged problems. Recovery from Achilles tendon injuries can be lengthy, anything from 9-12 months for a complete rupture and 6-8 months for a partial rupture.

Age – the degeneration of the tendon – and training changes can lead to Achilles tendinosis.  Stiffness in the morning and accompanying training are signs.  Rehabilitation from tendinosis varies between individuals so a timescale is not always possible.  Runners may be able to return to training within 3-6 months. Cycling and water jogging (or other non-pounding activities) are good rehabilitative activities.

Achilles bursitis occurs in the superficial bursa between the skin and the posterior of the tendon. It is susceptible to pressure from shoes and can become inflamed. The deeper bursa between the tendon and the calcaneus can also be irritated by external pressure or a partial tendon rupture. Recovery is similar to that of tendinosis.

Exercises include heel raises for both the gastrocnemius and soleus which can progress from standing on the floor to starting from a lowered calcaneus position (ie at the edge of a step). Water jogging and cycling are good activities to undertake.

4 August 2016