ACHILLES PAIN

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The Achilles tendon is a thick band of tissue that runs downs the back of the leg. It is the longest tendon in your body and connects your calf muscle to the heel bone.

Its primary job is to pull the heel bone, allowing your heel to lift off the ground while taking a step. Thus, it becomes the driving force behind your walking. When your Achilles tendon is affected your gait changes, which can lead to heel pain and other conditions commonly seen in the foot and ankle.

Commonly, an individual with an Achilles condition will experience pain and discomfort to the back of the heel. The most common disorders associated are Achilles tendonitis, followed by Achilles tendinosis.

An initial inflammation of the Achilles tendon is known as Achilles Tendonitis. This is an acute, short-lived condition where pain, swelling and difficulty walking develops to the posterior heel. Over time, the condition can progress to where the tendon degenerates and loses its organized structure. This can lead to microscopic trauma and tears to the tendon with scar tissue build up and know as the chronic form Achilles Tendinosis.

An Achilles tendon rupture is a complete tear to your Achilles tendon. Typically, a traumatic condition occurs where the pull of the tendon overpowers its norm resulting in the tendon to tear. Patients with chronic Achilles tendinosis are more prone to rupture due to the tissue band being weaker.

HOW ARE ACHILLES CONDITIONS FORMED

The most common cause for Achilles conditions is overuse of the tendon. A sudden increase in repetitive activity can cause excessive pulling of the Achilles tendon, causing too much stress too quickly. The tissues become injured due to micro-trauma to its fibers. Continuous activity and stress to the tendon prevents the body from repairing the injured tissue.

The term “weekend warriors” become a common explanation for patients who show Achilles pain. These individuals put excessive stress on their feet and ankles infrequently, making them prone to sudden, abrupt injury or pull of the tendon. The additional demands on the Achilles tendon result in its overuse.

SYMPTOMS

  • Pain at back of the heel.
  • Pain with first steps in the morning or after periods of rest, improves with walking but later worsens as activity increases.
  • Tightness to Achilles tendon.
  • Stiffening of toe in a flexed position.
  • Swelling and excessive tenderness with possible bump formed at back of the heel or on the tendon.

TREATMENT

The severity of the condition determines the type of treatment plan initiated. Often, an x-ray or other diagnostic imaging is indicated to assess the heel bone and Achilles tendon in detail.

Conservative treatment options are utilized to decrease the inflammation and pain of the tendon itself while offloading its use, allowing it to stay in a “relaxed” position. Some common treatment modalities include:

  • Rest and Icing.
  • Prescription medications such as anti-inflammatories or oral steroids.
  • Heel lifts.
  • Walking Boots.
  • Achilles braces and compressive sleeves.
  • Night splints.
  • Physical therapy.
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At Premier Foot & Ankle, we’re proud to offer an advanced and new conservative option called EPAT or Shockwave therapy. The treatment involves shockwaves sent to the inflamed area, resulting in a breakdown of scar tissue and inflammation, allowing for growth of healthy, stronger tissue. The treatment has shown to have a very high success rate to our patients and is a great alternative to surgery!

If conservative options fail, surgical intervention may be necessary. An MRI is typically ordered to understand the severity of inflammation and disease, acting as a guideline for surgical planning. The patient’s age, activity level and medical history will all play a factor in determining the best procedure to repair the tendon.

There are preventive measures that can be done to prevent overuse of the Achilles tendon:

  • Stretching and strengthening the calf muscles daily, including before and after heavy activity.
  • Orthotics or shoe inserts with stiff heel cups that supports excessive motion of the foot and overuse of the Achilles tendons. Soft, cushioned inserts usually do not help control the motion of the foot and is only a temporary relief.
  • Icing heel after long periods of activity or high impact exercises.

If you are exhibiting early indication of pain or discomfort, visit your podiatrist at Premier Foot & Ankle for care!

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