Wednesday, August 29, 2012

MY PAINFUL ACHING ACHILLES



The Achilles tendon is the largest tendon in the body.  It connects the calf muscle to the heel and is commonly injured with an explosive-type injury, such as a running start; it can also be an injury that happens over time where you have chronic heel pain, which eventually will result in acute pain and then loss of ability to push off with the foot.  This is loss of what we call plantar flexion.  This is a very common problem. It can be treated nonoperatively with heel lifts and boots, as well as judicious use of injection and physical therapy.  Normal symptoms the patient will complain about will be tenderness and swelling along the Achilles tendon.  This can be found both in the midsubstance of the tendon in the back of the heel or it can be actually where it inserts on the heel bone or the calcaneus.  These are both treated in a different fashion.  The non-insertional Achilles tendonitis is what we find in the middle of the tendon and tends to affect younger and active people.  This is normally the area that we see in a rupture of an Achilles tendon.

Insertional Achilles tendonitis is more of a chronic condition with tenderness where the tendon attaches to the heel.  There can be associated both tendonitis as well as with bone spur formation in this area that may need to be addressed by removing that bone spur.  There can be calcification of the tendon insertion, as well.  I refer you to the radiograph that shows the calcaneus, which shows evidence of a large spur where the Achilles attaches, as well as a very sharp, bony prominence on the heel bone itself that can irritate the Achilles and may need to be removed.  

Tight calf muscles can also aggravate the Achilles tendon, and stretching of the calf muscles is important; this, as well as warming up before doing a run or performing any aggressive physical activities.

Symptoms:  Common symptoms are pain after exercising, a thick tendon, pain and stiffness along the Achilles tendon while running, and swelling in the foot.

Tests:  Commonly utilized tests will be radiographs as well as magnetic resonance imaging, both of which are noninvasive and will help evaluate the bony insertion as well as the tendon and the health of the tendon.

Treatment of the Achilles Tendonitis:  In most cases, nonsurgical.  We are aggressive on treating this with calf stretches, what we call heel drop stretches, as well as single-leg heel drop.  See photos.  Other treatments that have been done are cortisone injections, shoes and orthotics, and extracorporeal shockwave therapy.  This is not normally performed at this day because the results have been inconsistent.

Written by Paul Spezia, DO

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