Achilles Tendinopathy & Anterior Ankle Impingement

by Melinda Burris Willms

         This article focuses on two conditions that disproportionately effect hurdlers because of the repetitive motions required of them when pushing off and landing: Achilles tendinopathy–a common complaint that refers to tendon pain, and anterior ankle impingement–an injury that occurs when too much pressure is brought to bear on the front of the ankle when landing. The symptoms of these conditions as well as diagnoses and treatments are discussed below.

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Achilles Tendinopathy

         This all too prevalent injury is known by many names including Achilles tendonitis and Achilles tendon pain. In recent years, Achilles tendinopathy has become a favored term used by health professionals to encompass a wide range of conditions of varying levels of severity that refer to inflammation of the Achilles tendon and other maladies affecting the lower calf and heel. Hurdlers are often at risk for Achilles tendinopathy due to overuse caused by the repetitive motion required in the jumping motion.1 While this overview discusses some generalities about the condition, it should be noted that the severity of pain caused by Achilles tendonitis and its effect on an athlete’s performance and career can vary from mild discomfort to excruciating pain.2

         Tendons are fibrous and connect muscle and bone. Tendon injuries tend to occur close to joints and for hurdlers, they often occur near the ankle or the knee. Though tendon injuries can seem to occur spontaneously, these injuries frequently take place over a span of time as tiny tears develop in the tendon due to wear and overuse.1

Achilles Tendinopathy Symptoms

v Achilles tendinopathy often presents as a painful burning sensation felt at the beginning of exercise that abates as the activity progresses but then returns with more severity when the exercise has ceased.1

v People with Achilles tendinopathy often complain of stiffness upon waking in the morning or at the start of athletic activity.1

v The pain is often exacerbated when the affected individual attempts to use the Achilles tendon.1

v The tendon is often red and tender. It may feel warm or you may feel a swollen lump if it is inflamed.1

Achilles Tendinopathy Diagnosis

         Generally, diagnostic imaging is not required to properly diagnosis Achilles tendinopathy.  A health care professional will assess your condition based on your history, the symptoms you present, and a clinical assessment. A proper diagnosis is instrumental in making a proper and full recovery.1

Precautions to Take to Avoid Achilles Tendinopathy:

v Train on a variety of surfaces: grass, asphalt, etc.1

v Avoid over-training by increasing your training regimen in realistic increments.1

v Mix up your training routine wherever possible to avoid repetitive movements.1

v Be sure to wear footwear that supports the entire foot: arch, heel, and ankle.1

Risk Factors for Achilles Tendinopathy

As has already been mentioned, participating in sports that require repetitive motion such as jumping hurdles puts athletes at a higher risk for developing Achilles tendinopathy. Other risk factors identified by Coach Carl Valle are identified below:

v A history of previous tendon injuries puts you at a higher risk for future injuries.2

v Previous injuries to joints and soft tissue could lead to Achilles tendinopathy if weight is improperly disturbed to alleviate pain.2

v Age and gender do play a role as older males run a higher risk of Achilles injuries.2

Prognosis and Treatment

   Current scientific understanding of the Achilles tendinopathy defines the condition as “a continuum of pathological processes”, which means that in order to properly treat you, it must first be determined what phase of the injury you are currently in.1 Once this has been established, a plan of  Isometric exercise—types of exercise where the joints remain static, planks for example, are prescribed to avoid load bearing on the distressed tendon.1

Ankle Injuries Commonly Experienced by Hurdlers

Anterior Ankle Impingement

   This condition is most frequently caused by the sprain or repeated sprains of the ankle. Hurdlers are at increased risk for anterior ankle impingement because of the maximal dorsiflexion of the ankle required to land after jumping.3 To move the ankle in this way, “the foot and shin move towards one another” while the shinbone advances towards the talus bone in the ankle.3 This movement puts “compressive forces” on the ankle joint at its front.3 When these forces go beyond what the ankle can bear, inflammation and other structural damage may result.3

Symptoms of Anterior Ankle Impingement

v Typically, the front of the ankle aches when the person is not active, but when the individual does maximal dorsiflexion, the pain becomes acute.3

v Traversing uphill or across uneven surfaces, doing squats and lunges will also often increase pain levels.3

v Swelling or tenderness of the ankle joint.3

Diagnosis of Anterior Ankle Impingement

v This condition can be diagnosed by a health care professional based on medical history and a physical examination.3

v X-rays may be used to confirm diagnosis in some cases and can identify if bone spurs are present.3

Treatment for Anterior Ankle Impingement

v The first step in treating this condition is to address the pain. To do that, you need to get rest and avoid all movements that irritate the injury.3

v Applying ice to the injury site when you feel heat or swelling for 20 to 30-minutes every 2-4 hours will provide relief.3

v Using a compression stocking or applying compression by using a bandage or kinesiology tape will provide support to the tissue surrounding the injury and alleviate swelling.3

v Simply keeping the ankle elevated above the heart will also reduce swelling.3

v Non-steroidal anti-inflammatory medications such as ibuprofen may also be helpful.3

         As soon as your symptoms subside, it is important that you begin to exercise again to restore your regular level of exercise and ability.3

References

1. Miller, J., Russell, Z., Kearney, A. What is Achilles Tendinopathy? 6 August 2019.
2. Valle, C. Achilles Tendon Injuries in Sport: A Coach’s Perspective.
3. Armfield, S. Track and Field Injuries. 19 January 2018.

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