There are many causes of heel pain and the most common problems that we see include achilles tendinitis and tears.
Case Study: A 46-year-old active male recently attended our Lincoln clinic following an injury to his right Achilles tendon.
He reported to have injured his Achilles playing squash when he felt a sudden pop in his calf. He was unable to weight bear due to pain, and a visit to A+E that day confirmed he had sustained a partial rupture of his Achilles tendon. It was recommended by his consultant that he avoided surgery due to a large percentage of the tendon remaining intact.
The management plan consisted of 4 weeks in a cast with heel raises. This was followed by a further 4 weeks in an air boot with heel raises. From week 5, a heel raise was reduced each week and by 8 week he was walking in an air boot with no heel raise. At this point, he transferred to a trainer with one heel raise and an intense rehab program commenced.
During his time in the air boot, soft tissue therapy was administered weekly. This encourages the re absorption of swelling and release tightness and contractures that have developed within the muscles. At week 8, his rehab consisted of balance drills and strengthening exercises and was consistently progressed to more advanced exercises.
At week 12, a one-hour rehab session was booked for 12 consecutive weeks. This enables us to treat, reassess his rehab exercises and progress them where necessary. In addition to his weekly 1-1 physio sessions, it was agreed that he would repeat the session independently 3 further times each week. Ice was applied to the injured area 3-4 times a day for 20-minute intervals to control any reactive swelling from loading.
This level of input is excellent for maximising recovery. It enables weekly progressions of exercises and keeps the rehab moving forwards, ensuring the Achilles is getting stronger but at a pace that the Achilles tendon can tolerate.
When does Achilles tendinitis or tear need surgery?
Not all Achilles tendon injuries require surgery. The appropriate treatment for an Achilles tendon tear depends on the severity of the injury, as well as the patients overall health and activity level. In many cases, non-surgical treatments are effective in promoting healing.
Surgery is considered when there is an Achilles tendon rupture or when conservative treatments have not been effective. Surgical repair involves reattaching the torn ends of the tendon.
The decision to pursue surgical or non-surgical treatment depends on factors. This includes the extent of the tear, the patients age, activity level, and overall health. Conservative management is often the first line of treatment, and surgery is considered when other methods have not provided sufficient improvement or when there is a complete tendon rupture. Physiotherapy plays an enormous role in ensuring a full recovery and failure to complete a specific rehab program will often lead to re rupture and/or complications.
What causes Achilles tendon injuries?
Although Achilles tendon ruptures are not uncommon, it is much more common for us to see patients with an Achilles tendinopathy. Achilles tendon tears are usually caused from a sudden or forceful movement such as a jump or acceleration. Tendinopathies develop over a longer period of time from overuse or repetitive stress.
Achilles tendinopathy refers to a condition where the tendon becomes irritated, inflamed, or damaged due to overuse or repetitive stress. There are two main types of Achilles tendinopathy: Achilles paratendinitis (inflammation of the tendon sheath) and Achilles tendinosis (degeneration within the tendon). The symptoms of Achilles tendinopathy can vary depending on the severity of the condition.
Symptoms of Achilles Tendinitis
1- Stiffness and pain first thing in the morning when putting your heel down.
2- Pain when walking. This may ease off after a certain distance or get worse depending on how severe your symptoms are.
3- Pain in the lower leg just above the heel that often gets worse over time.
4- Stiffness in the Achilles tendon after a period inactivity.
5- Tenderness: the Achilles tendon may be tender to touch and there may be a thickening on the tendon.
6- Gradual symptoms: Symptoms of Achilles tendinopathy typically develop gradually over time. As opposed to an acute injury where symptoms develop suddenly such as with an Achilles tendon rupture.
Treatment options for Achilles tendinitis
The treatment for Achilles tendinopathies typically involves a combination of self-care measures, physical therapy, and, in some cases, medical interventions. The goal of treatment is to reduce inflammation, relieve pain, promote healing, and improve biomechanics.
Here are some common approaches to managing Achilles tendinopathies:
1- Rest and Activity Modification: Avoid activities that exacerbate the pain and put additional stress on the Achilles tendon. Give your tendon time to heal by reducing or modifying your physical activities, especially those involving repetitive jumping or running.
2- Ice: Apply ice to the affected area for 15-20 minute, 3-4 times a day. This can help reduce inflammation and reduce pain.
3- Orthotics: Orthotic insoles can improve foot posture and reduce strain on the Achilles tendon.
4- Manual therapy: by manually treating the Achilles tendon, circulation can be enhanced and improve healing as well as releasing tight calf muscles that are contributing to Achilles tendon pain. Soft tissue therapy can release tightness in the gastrocnemius and soleus and alleviate tension and strain on the tendon.
5- Shockwave therapy: Where symptoms have not responded to physiotherapy, shockwave therapy is a good option for stimulating blood flow and tissue repair.
If have or are experiencing an Achilles tendinitis or tear, it is important to remember that every persons condition is unique. Adherence to a specific rehab program are essential for a successful recovery. If you are struggling with Achilles pain and need some free expert advice you can request a free call with a member of the team.
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