Treating Heel Pain: Achilles Tendonitis

December 28, 2011 Posted by Dr.Chang

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.


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