Sally Child is Podiatrist who currently consults at the Olympic Park Sports Medicine Centre and for the Richmond Football Club. Recently Sally completed her Master of Sports Medicine (by Research) at the University of Melbourne. Her research focused on Achilles tendinopathy and the mechanical behaviour of the Achilles tendon in running athletes. Her main findings were published in The American Journal of Sports Medicine in 2010.

The following is a brief overview of her research:

Background

Achilles tendinopathy is a common injury sustained by running athletes and is often managed by a team of sports practitioners including physicians, physiotherapists and podiatrists.

Whilst the exact mechanism of injury is still unclear, changes to injured tendon are often seen both on clinical assessment and at a microscopic level. Quite often people affected by Achilles tendinopathy will report a sensation of “stiffness” in their tendon, tending to suggest that the tendon is less flexible. The tendon will appear thickened and swollen and changes will be seen on ultrasound.

Currently the most common approach to treatment is a 12 week strengthening program. Other treatment may include, but is not limited to, lower limb biomechanical correction via sporting footwear and foot orthoses, physiotherapy, injections and extra corporeal shock wave therapy.

Project aims and data collection

The aims of this research project were to determine whether an Achilles tendon affected by tendinopathy is less flexible than healthy tendon and whether clinical tests carried out by Podiatrists differ between those people with and without Achilles tendinopathy.

The project involved testing 50 male runners (25 diagnosed with Achilles tendinopathy and 25 healthy controls). Females were not included in this study as hormonal changes across the menstrual cycle have been shown to alter the flexibility of the Achilles tendon. Data collection involved a number of different tests with a particular focus on the flexibility of the Achilles tendon. The main measure utilised highly specialised equipment, involving ultrasound, to measure how much the Achilles tendon stretched when the calf muscle contracted. Knowing whether this tendon flexibility differs between athletes with and without tendinopathy may help in developing management plans and identifying risk factors for the development of Achilles tendinopathy.

Project findings

Despite what you would think, the Achilles tendinopathy group had more “stretch” of the tendon compared to healthy controls. This may be related to the disruption of the tendon fibres seen in injured tendon under the microscope – almost like a rope unravelling when some of its fibres are cut. This might help to explain why calf strengthening programs can aid in reducing pain and improving physical capacity in people with Achilles tendinopathy. Previous studies have shown that collagen production is increased after strengthening programs, thus more ‘fibres are woven into the rope’. This is a ‘chicken and egg study’. We cannot tell you which came first – the tendon symptoms or the changes we found in the tendon however, we believe these findings contribute greatly to our understanding of tendon injury and treatment.

For additional help and advice about achilles tendinopathy and the role of podiatry in its treatment, make an appointment to see Podiatrist Sally Child or contact the OPSMC podiatry department.