Injuries to the Achilles tendon, the tissue that connects the calf muscle to the heel bone, can cause considerable heel pain. The most common Achilles injuries are Achilles tendonitis and tendonosis, the former being inflammation of the Achilles tendon and the latter being degeneration of Achilles tendonitis. The inflammation from Achilles Tendonitis is usually short-lived. Over time, if tendonitis is not treated, it can degenerate into a worse condition called tendonosis, marked by tears in the tendon. In rare cases, chronic degeneration with or without pain may result in rupture of the tendon.
The most common risks to the Achilles, similar to the prognosis for stress fractures, are sudden increases of repetitive activity without giving the Achilles tendon the proper time to repair itself from the micro-injuries to the tendon fibers caused by intense activity. Additionally, Achilles injuries may be due to physiological reasons such as flat feet, which put extra pressure on the tendon while walking or running.
Achilles tendonitis and tendonosis will result in pain, aching and tenderness along the tendon’s path, increasing when the sides of the tendon are squeezed but with less pain in the back of the tendon. To diagnose Achilles injuries, your podiatrist will examine the foot, its range of motion, and may conduct further assessment with imagining techniques such as X-rays.
Treatment plans for Achilles tendonitis and tendonosis will focus on reducing force on the Achilles tendon by means of a cast or walking boot, reducing swelling with ice and oral medications, long term preventative strategies such as over the counter and custom orthotics and night splints, and gradually building a physical therapy regimen that includes stretching and strengthening exercises, soft-tissue massage and mobilization, and ultra-sound therapy.
One major factor in Achilles injuries is excessive tightness of the posterior leg muscles and even connected tendons, so physical therapy and long term maintenance will include light calf stretches, hamstring stretches, and plantar stretches after warming up, to ensure the health of your Achilles. You may even want to consult your podiatrist and physical therapist about working on your gait and stride while running, as gait abnormalities can lead to Achilles tendon and other injuries. Your training plan might need to be altered – working out for fewer hours per week, cutting down on speed work, hill repeats, strengthening and plyometric work, and avoiding excessive stretching. Specific methods of taping may also help to take pressure off the Achilles and to increase blood flow to the affected area.
Additionally, your doctor will suggest the proper footwear for you to recover or point you toward shoe experts. For example, soft cushioned soles or air filled heels can contribute to Achilles injuries since they make the foot sink lower in the shoe to absorb the shock of heel strike, thereby stretching the Achilles tendon with each stride more than a firm-soled shoe would.
Achilles ruptures are usually treated with surgery. This surgery will effectively stitch the lesion in the tendon. Brace yourself – after an Achilles rupture you’re in for a long recovery. Achilles injuries are often followed by at least 12 weeks of casts, braces and splints. Current research suggests that, depending on the degree of injury and individual constraints, early motion can be an acceptable form of rehabilitation (which would include light physical therapy immediately after the surgery). In either case, your podiatrist will probably suggest that you wear a heel lift for up to one year after the removal of the cast. In recovery, a range of care will be required that includes physical therapy, icing, taping, non-steroidal anti-inflammatory drugs. Consult your podiatrist for the appropriate treatment plan for your ankle pain.
Catching and treating Achilles injuries early is key to healing successfully. Once you start feeling Achilles pain do not ignore it. Visit Dr. Murray and Dr. Chang, your Charlottesville and Waynesboro podiatrists, and they can help you construct a treatment plan and all sorts of preventative exercises that are right for your individual injury. In many cases, there are preventative measures within your control before a severe Achilles injury stops you from running or engaging in your day-to-day activities.
Fractures can be another cause of heel pain. Your heel bone, called the calcaneus, can incur fractures like any other bone. Calcaneal fractures, however, are dangerous because of the physiology of the calcaneus and the bones with which it forms a joint. The breaking of the calcaneus’s thin, yet hard outer shell reveals a softer bone inside that shell. Once the outer shell is broken, the entire bone is prone to collapse and fragmentation. Breaking the calcaneus can have negative effects on the joint it creates with the talus and cuboid bones, bones further of the foot. A fracture that disturbs the joint (inter-articular fractures) can cause damage to multiple bones and the cartilage between, and could have long-term effects including arthritis and chronic pain.
Calcaneal fractures are usually caused by traumatic events: big falls, car accidents and the like. Like other stress fractures, calcaneal fractures can also be caused by overuse or repetitive stress on the heel. Pain can vary, depending on whether the fracture is traumatic or not. Some patients with calcaneal fractures report not being able to put any weight on their foot, and others report pain and symptoms similar to that of plantar fasciitis (general pain growing progressively worse over a number of days or weeks). Calcaneal fractures, however, will produce pinpoint pain after pressing down on the middle or sides of the heel bone, which does not usually occur with plantar fasciitis. Additionally, in your primary assessment and to reach a correct diagnosis, your podiatrist will inquire into your recent activities (since, often, abrupt increases in exercise or sudden weight gain can cause calcaneal stress fractures), and may take an X-ray to examine the bone.
The most important thing to consider when treating calcaneal stress fracturesis the time they take to heal. Do not wait to treat stress fractures, or to visit your podiatrist for a diagnosis. If treated improperly or ignored, stress fractures will only worsen with time or reoccur, even leading to deformities that restrict motion and activity, cause arthritis and make shoes incredibly uncomfortable.
Your podiatrist and you can work together to find the proper treatment plan for your injury, which will likely include a combination of rest, immobilization with a caste or rigid shoe, avoiding the aggravating activity, ice, NSAIDs, physical therapy for rehabilitation, and surgery in extreme cases. Non-operative treatment of calcaneus fractures will range from limiting weight bearing activities and the use of crutches, limiting motion through casting, splinting or bracing for a short period of time, and range-of-motion exercises so that your muscles don’t atrophy and the blood keeps circulating to the healing area that needs it most. Be patient with your injury, as it takes time, usually around three months, to heal stress fractures. In extreme cases, or in the case that you have poor circulation or diabetes, surgical approaches for calcaneus fractures may be a good option for your injury. Be sure to discuss the benefits of surgical treatment with your podiatrist.
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