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Achilles Tendonitis

Achilles Tendon

In order to understand Achilles tendonitis, we must understand the Achilles tendon.  Per WebMD, “the Achilles tendon is a tough band of fibrous tissue that connects the calf muscles to the heel bone (calcaneus)”.  The gastrocnemius and soleus muscles (calf muscles) blend together, becomes the Achilles tendon, and inserts into the heel.  

This inflammation can be caused by numerous things:

  • Activities involving quick acceleration, deceleration, pivot, or putting a quick stretch on the tendon.
  • Leg and calf muscles that are too tight.
  • Having “flat feet”.  When you take a step, the arch of your foot collapses and stretches the muscles and tendons of the foot and lower leg.
  • Wearing high heels.  Doing this shortens your gastroc/soleus and Achilles tendon and may cause tightness.
  • Per WebMD, taking medicines called glucocorticoids or antibiotics called fluoroquinolones.

This inflammation can cause difficulty walking or even difficulty wearing shoes that have contact at the heel or the back of the foot.

Treatments:

  1. R.I.C.E. (rest – ice – compression – elevate)
    1. Rest your leg.
    2. Ice it. Ice your heel/calf for 15-20 minutes every 3 to 4 hours to reduce pain and swelling.
    3. Compress your leg.  Use an elastic bandage around the lower leg and ankle to keep down swelling.
    4. Elevate your leg
  2. Take anti-inflammatory painkillers or nonsteroidal anti-inflammatory drugs like ibuprofen and naproxen to help with pain and swelling.

Once diagnosed,

  1. Use a heel lift or an insert in your shoe while you recover to help protect your Achilles tendon from further stretching.
  2. Soft tissue mobilization/massage (STM) to add circulation and work the mobility of calf, tendon, and surrounding tissues.
  3. Gently stretching and mild strengthening exercises to assist with decreasing muscle and tendon tightness and assist with return to normal function.

GASTROC STRETCH:

Gastroc Stretch

 Put towel around the ball of the foot.  Gently pull towel to stretch the back of calf.  Hold 20-30 seconds and repeat 3 times.

PLANTARFASCIA STRETCH:  

Plantarfascia Stretch

Use tennis or golf ball under the arch of the foot.  Roll from the base of toes to the heel.  Roll for 2 minutes.

GASTROC STRETCH:  

Gastroc Stretch

Stand with one leg back with toes forward, heel down, and leg straight.  Lean forward until a gentle stretch is felt in the back lower leg (calf).  Hold 20-30 seconds and repeat 3 times.

SOLEUS STRETCH:  

Soleus Stretch

Stand with one leg back with toes forward, heel down, and slightly bent back leg.  Lean forward keeping the back leg bent until a gentle stretch is felt in the back lower leg (calf).  Hold 20-30 seconds and repeat 3 times.

STRENGTHENING:  Strengthening needs to be slow and symptom-free (you don’t want to aggravate the tendon again). Eccentric strength work usually benefits the patient well at this time.

Kinesio Tape to help alleviate symptoms and decrease tension in tendon.

Achilles Kinesio Taping

  • See figure 1 – Inhibition I-strip to Achilles tendon.
    1. Sometimes a double strip works better if pain is defuse.
  • See figure 2 – Apply a “decompression or Band-Aid” piece of tape using stretch over the area of the most pain if there is a specific painful spot.

Something that can be frustrating for people dealing with Achilles tendonitis is the recovery time.  Once the tendon is inflamed and is symptomatic, then decreasing the symptoms and improving the mobility of the Achilles tendon and calf musculature is slow and can easily have flare-ups.  Complete recovery can take a long time even up to months.  Being patience and staying the course is really what is needed.

About the Author - Laura

Laura was born and raised in Poway, CA, and is a southern California girl through and through. She went to college at Loyola Marymount University where she played basketball and rowed crew. She received her Physical Therapist Assistant degree from San Diego Mesa College, and she has been working as an outpatient, orthopedic PTA for 14 years. She started her career in Los Angeles, CA, working for HealthSouth and Select Medical at the Kerlan Jobe Orthopaedic Clinic for 9-10 years. Laura came back home to San Diego about 4 years ago, and has been working with ProActive Physical Therapy and Sports Medicine ever since. She works out of the 4S Ranch and Vista clinic as well as covering at the Carlsbad clinic where she began with the ProActive family. She ran the Aquatic Therapy Program at Kerlan Jobe for 8-9 years, and now has been in charge of the ProActive’s Aquatic Therapy for 1-2 years. Her other career passion is working with Industrial Rehab and Worker Compensation patients. She has been performing Functional Capacity Evaluations (FCE) and POETS (Post Offer Employment Tests) for 12-13 years, and has worked with companies like Chevron, Union Pacific Railroad, American and Hawaiian Airlines, and Chrysler. She loves working with and helping people get back to what they want to do if it is walking their dog to driving a gas trunk to going on a trip with their grandchildren.

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