achilles tendonitis

In Greek Mythology, Achilles was considered one of the most handsome and greatest warriors in the Trojan War as well as the central character in Homer’s Iliad. It was said that the only vulnerable area in his body was his heel. Given Achilles died by having an arrow shot thru his heel, today the term “Achilles heel” is in referendum to the person’s area of weakness.

Pain and or tightness are usually the first symptom runners notice when a structure is loaded beyond its capacity. The Achilles tendon itself runs along the lower 1/3 of the leg attaching onto the calcaneus. At the insertion point, the reader should notice the blue structure, “calcaneal bursa.” There are 2 bursa; a large one between the fat pad and the heel bone as well as a smaller one that is located at the attachment site of the tendon onto the bone. A normal healthy bursa is like a flat balloon with oil inside it. Our bodies’s have several bursas throughout and serve to allow tendons to glide and slide easily over structures. The classic sign of an inflamed bursa is pain that awakens you in the middle of the night. As you sleep, fluid seeps into the bursa causing it to swell. When you get up and walk around, your muscles “pump” some of the fluid out over a period of minutes to an hour or so and your symptoms lessen. With tendonitis, in the early phase, it may hurt all the time or with certain movements and then only with use. Tendonitis is tearing of some of the fibers within the tendon. Left untreated, cellular changes occur and the tendon loses its white, glistening appearance and becomes fibrotic. A fibrosed tendon may have an increased disposition to tear. Equally, continual overloading of a structure with tears on the microscopic level will eventually lead to macroscopic tears and ultimately tendon failure (rupture). You will know immediately if you have completely ruptured your Achilles tendon. Aside from the pain, your ability to walk is all of a sudden like the “clomp of a horse.” This is due to loss of the muscles ability to function eccentrically. The test for Achilles rupture is performed by laying on your stomach with your feet hanging off the bed; have someone squeeze your calf muscle at the wide part of the girth on the unaffected side; he/she will see your foot moves as if it’s pointing each time he or she squeezes. On the side of suspected rupture, squeezing will have no effect on the foot (no movement will be noted). If a partial tear has occurred provocative tests (squeezing) may or may not be conclusive. In the event of a complete rupture, surgical repair is necessary. If you suspect you may have some degree of tear; immediately see an orthopedic surgeon who is reputable. Fortunately, Stockton has some great orthopedic surgeons who have high success rates performing an Achilles tendon repairs. If you do not already have a surgeon, please feel free to contact my office and we can recommend one for you based on your insurance and clinical outcomes.

Self treatment for tendonitis starts with stopping activities that aggravate the tendon. (For those of you who can’t fathom stopping running, I suggest you log onto You Tube and search for Bob Newhart “Stop It”…..watch it & you’ll get my point!). Riding a stationary bike is an option for cardiovascular conditioning while you are recovering. Immediately when symptoms arise remember the acronym: RICE (rest ice compression and elevation). You may place a small heel lift in your shoe to decrease the tensile (stretch) load (6-9mm). I have my patients put the lifts in both shoes so as to not alter the position of the pelvis. Another device readily available online is called Pro-Tec Achilles Wrap. OTC’s such as Motrin/Ibuprofen and Aleve can be helpful; check with your physician to make sure you do not have any underlying health issues prohibiting use of this medicine. Always take OTC’s with food and stop immediately if gastric upset occurs. Ice the tendon for 20 minutes 5-6 times per day. When the intense pain starts to ease, hopefully day 3 or 4, start a very gentle stretching program. Heat the tissue first then stretch, always ending with ice. As tolerance increases, use a device called “Pro-Stretch.” If symptoms persist more than 7-10 days or you want to expedite resolution of the problem, please seek treatment with our office. The use of cold laser, ultrasound with anti-inflammatory agents, iontophoresis, electrical stimulation along with a thorough evaluation to determine the cause of onset are some of the treatments used. Kinesiotaping is also used; you may have seen this tape on the Olympic Beach Volleyball players.

Devra A. Bommarito, PT
XCEL PHYSICAL THERAPY
STOCKTON / RIPON
devra@xcelpt.com
209. 546.0944