Achilles heel pain is a condition in which the large tendon in the back of the ankle becomes irritated and inflamed. In the body, the Achilles tendon is the largest and most vulnerable tendon that connects the heel bone and the calf muscle (gastrocnemius). Achilles tendon is also known as the ‘heel cord’ that supports the entire body weight and helps to lift the heel off the ground, so facilitating walking. When the Achilles tendon gets inflamed, it is referred as Achilles tendonitis. Achilles tendon can experience pressure of up to 1,000 pounds of force but it also ruptured more frequently than any other tendon, and is vulnerable to inflammation or injury called tendonitis.
The calf muscle crosses the knee, the ankle, and the subtalar joints and can generate stress and tension in the Achilles tendon. Achilles heel pain is a common overuse injury that tends to take place in middle-age recreational athletes. The overuse causes inflammation and resulted in pain and swelling. It can cause pain with every step he or she takes and symptoms are varied from slight tenderness along the Achilles tendon to a sharp burning pain on the back of the heel. Achilles tendonitis may or may not be escorted by swelling. This condition is commonly observed in runners and they usually experience pain after periods of rest, which recovers when in motion but get worse with increased activity.
Two main types of injuries affect the Achilles tendon: Achilles Tendonitis and Achilles Tendon Rupture.
1. Achilles Tendonitis:
Simply, it is an inflammation of the tendon that causes pain. In most cases, it is caused by excessive training over an extended period of time.
2. Achilles Tendon Rupture:
It is a tear (or complete snapping) of the tendon that causes pain and disability to the affected foot. Generally, it takes place as the result of a sudden or unexpected force. A complete ruptured Achilles tendon is treated only by placing the lower leg in a plaster cast for 6 to 8 weeks, or surgery.
Causes of Achilles Heel Pain
Usually, Achilles pain is caused by sudden increase in the frequency of repetitive activity involving the Achilles tendon that burdens the tendon with too much pressure in a short time. It causes micro tears at the attachment to the heel bone. As the stress is incessantly applied, even after the micro-injury, the body is incapable to repair the damage. Alteration of the tendon structure leads to intense, continuous pain.
Hyperpronation or excess rolling of the foot causes the heel to lean that result in the extra application of strain on the tendon. This is resulted as people who hyperpronate have their arches fall from the non-weight bearing position or sitting position, to the weight bearing or standing position. When the arches fall, the ankles roll in and the heels lean in. Leaning in of the heels leads to increased tension on the inner attachment of the tendon, resulting in pain.
Another cause of Achilles pain is rubbing of the shoe heel counter against the tendon attachment area. Inappropriate shoes that traits extremely stiff soles, limit the forefoot movement, and leads to tendon pain. In women who wear high-heeled shoes, the tendon gets shortened. When these women wear flat shoes and run, the pressure is increased in tendon and results in pain.
Another contributing factor of heel pain is excessive heel cushioning, according to certain studies. Some shoes are specially designed to give better shock absorption and in such shoes the heel makes contact with the ground and sinks lower as the shoe absorbs the shock. As a result, the stretching of the tendon takes place. Sudden increase in training, hill running, accidents, weak calf muscles or tendons, side effects from certain medications, etc. are the other causes of Achilles tendon pain.
Symptoms of Achilles tendonitis:
Pain over the back of the heel is the main complaint related with Achilles tendonitis. At this point, the tendon inserts on the heel bone. Usually, the patients who suffer from Achilles tendonitis experience the most significant pain after periods of inactivity. Patients experience pain after first walking in the morning and when getting up after sitting for long periods of time. The pain is also experienced in patients while participating in activities, such as when running or jumping. Achilles tendonitis pain related with exercise is most important when pushing off or jumping.
Symptoms of an Achilles tendon rupture:
As Achilles tendon rupture is a traumatic injury, it causes sudden pain behind the ankle. A person suffering from this may hear a ‘pop’ or a ‘snap,’ and will almost always say they feel as they have been kicked in the heel (even though no one has kicked them). Also, they have difficulty in pointing their toes downward, and may have bulging and bruising around the tendon.
Diagnosis of Achilles heel pain:
Diagnosis of Achilles heel pain is accomplished by history and physical examination. The symptoms linked with this condition are typical and can be elicited thorough a history. To determine the location of the problem, a physical examination is used.
In patients with Achilles tendonitis, X-rays are usually normal but are performed to assess for other possible conditions. To assess a patient for tears within the tendon, MRI is infrequently required. MRI may be helpful for preoperative evaluation and planning if there is a consideration of surgical treatment.
Treatment of Achilles heel pain
Achilles heel pain treatment depends on the degree of damage and duration of injury onset.
Treatments of Achilles tendonitis:
A period of immobilization can help to reduce the tension on the tendon during the early stages of the injury. A person suffering from this condition can also use a removable walking boot or sometimes even a cast that permits the inflamed tissue to cool down rapidly and so relieves pain.
Taking rest while suffering from the painful Achilles tendon will permit the inflammation to subside and also let sufficient time for healing. After the onset of symptoms, a period of rest is essential in controlling Achilles tendonitis.
- Ice application:
Ice application to the affected area can help to stimulate blood flow to the area, and relieve the pain linked with inflammation. You can apply ice after exercise, as well as several other times over the course of the day.
- Heel Wedge:
To minimize the stress on the Achilles tendon, a sufferer can also insert a heel wedge into the shoe. Heel wedge can be placed in both athletic shoes as well as work shoes.
- Anti-Inflammatory Medications:
These non-steroidal anti-inflammatory medications (NSAIDs) help to relieve pain. Examples of these medications are Ibuprofen, Motrin, Naprosyn, Celebrex, and many others. These medications can improve Achilles tendonitis and help to reduce pain and swelling. Before starting these medications, consult your doctor.
- Physical Therapy:
A stretching and rehabilitation program is included in the physical therapy. These techniques are mostly used by physical therapists that work on flexibility of the Achilles tendon.
Surgery is required when these non-surgical treatment methods fail to perform tendon healing. The foot and ankle surgeon suggests stretching and strengthening of the calf muscles through Achilles tendonitis exercises to prevent the reappearance of pain and injury after the surgery. To prevent further damage, the patient should also wear proper shoes.
Treatment of Achilles tendon rupture:
Most frequently, Achilles tendon rupture is treated surgically to rejoin the tendon to its normal position. Generally people who live sedentary lifestyles or who may have problems with wound healing, nonsurgical treatment can be carried out. It is accomplished by casting the Achilles tendon for several months. The number of re-ruptures is higher in these patients compared to those patients who have surgical repair. A person who has performed surgery for an Achilles tendon rupture has less than 3% experience a rerupture of the tendon.
To treat an Achilles tendon rupture, the surgery involves an incision along the back of the ankle. Generally, the incision is made just to the side of midline so shoes will not massage on the site of the scar. The ragged ends of the Achilles tendon are identified and strong sutures are placed in both ends of the tendon. To repair the tendon, these strong sutures are then joined together.
- Complications of Achilles tendon repair:
Wound healing problem is the most common and worrisome complications following an Achilles tendon repair. Sometimes, the skin over the Achilles tendon does not heal well. So, following surgical repair of an Achilles tendon rupture, careful wound management is of highest important. Rerupture of the tendon, ankle stiffness and infection are the other potential problems associated with Achilles tendon repair.
How to prevent Achilles Tendonitis?
Here are some things that can help you to prevent Achilles Tendonitis.
To prevent Achilles Tendonitis, some activities that challenge your ability to balance help to keep your balance. These activities are also called as proprioception that indicates whether the body is moving with required effort.
Warm Up properly:
To get the body ready for any activity, a good warm up is important. A well structured warm up will get ready your heart, lungs, muscles, joints and your mind for tiring activity.
It includes jumping, skipping, bounding, and hopping type activities. These explosive exercises prepare the muscles, tendons and ligaments in the lower leg and ankle joint and also help condition to heal.
Wearing good footwear is important as it will help to keep your ankles stable, give adequate cushioning, support your foot and lower leg throughout the running or walking motion.
Achilles Tendon Pain – Podiatrist video from Youtube:
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Achilles Tendon Physical Therapy Exercises : Achilles Tendon Massage Techniques video from Youtube: