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Foot Health / Problems
Achilles Tendinopathy

Introduction

Your Achilles tendon is a strong cord made of fibrous connective tissue that attaches your calf muscle to your calcaneus, or heel bone. Your Achilles tendon is located at the lower end of your calf muscles, and it is the continuation of your gastrocnemius and soleus muscles. This tendon is one of the strongest tendons in your body and is essential for performing many occupational and recreational activities, especially athletic activities.

Condition Information

Achilles tendinosis (a condition commonly—though erroneously—referred to as Achilles tendinitis) involves swelling and pain in your Achilles tendon. MRI studies reveal that this condition is characterized by collagen degeneration, not inflammation, in the affected area, as has been previously thought. This health problem can affect any part of your tendon, though it most commonly occurs at the point where your Achilles tendon attaches to your heel bone or less than 1 inch above this point. Shoes that continuously rub on the back of your heel may irritate your Achilles tendon and heel bone, causing a condition known as traumatic Achilles tendinitis, or pump bump.

The pain you experience with traumatic Achilles tendinitis can only be relieved by addressing the underlying source of the problem: footwear. Shoes that are too short in heel-to-toe length and shoes in which the heel counter—the rounded cup-shaped part of your shoe that covers the back of your heel—does not match the shape of your heel may cause a pump bump. Excessive motion of your heel bone during walking and other activities may also be a factor in this health problem. Examine the inside of your shoe’s heel counter to see if the material at the back of your heel is worn away.

Causes and Symptoms

Some of the most common causes of (or factors that contribute to) Achilles tendinosis include:

  • Conventional footwear (and foot position within the shoe)
  • A rapid increase in training volume and/ or intensity among runners, walkers, and other athletes (i.e.,  excessive repetitive overload of the Achilles tendon)
  • A rapid transition from running shoes with heel elevation to racing flats or spikes
  • Tight calf muscles (especially the deep flexor muscles in the back of the lower leg)
  • Arthritis and bone spurs (more common among middle-aged individuals and seniors)
  • Certain antibiotics and corticosteroids
  • Age, gender, weight, foot shape, and gait

Achilles tendinosis caused by a rapid increase in your training volume or intensity is called overuse Achilles tendinosis. Transitioning too quickly from shoes with heel elevation (including running shoes and high heels) to shoes with little heel elevation may cause Achilles tendinosis because your Achilles tendons have to stretch up to 1 inch, due to the contraction of this tendon that occurs from the prolonged use of high-heeled shoes. The stretching forces that your Achilles tendon experiences in this scenario are often sufficient to cause tendinosis-related signs and symptoms.

Often overlooked as a cause of Achilles tendinosis, we believe, is the role of footwear and foot position within the shoe. The position of the toes, in particular, has a significant effect on the attachment area of the Achilles tendon (this can be visualized—and experienced—by holding your ankle at 90 degrees and repeatedly flexing and extending your toes). Toe spring—a toe and foot deforming feature built into most conventional footwear—can cause tensioning in the Achilles tendon and restrict blood flow to the back of the ankle, which is a major cause of tissue degeneration in this area.

Common signs and symptoms associated with Achilles tendinosis include:

  • Pain and stiffness along your Achilles tendon that is worse in the morning and with activity
  • Extreme pain in your affected area the day following exercise
  • Achilles tendon thickening
  • Chronic, or long-term, swelling in or around your Achilles tendon
  • Bone spurs in your affected area
  • Observable changes in your gait

Treatment

The first (and most important) step in the conservative and natural management of Achilles tendinosis involves a move away from conventional footwear and toward foot-health-positive footwear. Avoid toe spring, heel elevation, and tapering toe boxes when selecting your footwear. Foot-health-positive footwear possesses a toe box that is widest at the ends of your toes and allows all your toes to spread (an action that can be further enabled with the use of Correct Toes). This foot and toe position helps optimize circulation in the foot tissues and encourages a balance in tissue tone between your toe flexor and extensor muscles/tendons.

A slow, gradual transition to foot-healthy footwear is necessary to ensure a successful outcome. This is especially true for individuals accustomed to shoes with heel elevation. Other recommended treatments for Achilles tendinosis include the following:

  • Rest
  • Adoption of a “sensible” training program
  • Key stretching and strengthening (especially eccentric) exercises
  • Massage
  • Cryotherapy
  • Physical therapy
  • Therapeutic ultrasound
  • Instrument-assisted soft tissue mobilization (IASTM)
  • Cold laser
  • Hydrotherapy
  • Nutritional supplementation

Traumatic Achilles tendinitis (pump bump) usually responds to appropriate footwear changes. Consider switching to backless shoes or sandals that place no pressure on your affected area.

Achilles tendinosis is a serious health problem and should be treated immediately to help avoid complications. Achilles tendinosis, if left untreated, may lead to prolonged pain and scar tissue formation. Scar tissue can decrease your Achilles tendon’s flexibility and increases your likelihood of experiencing a complete rupture (the tearing of your Achilles tendon away from your heel bone or into two pieces).

DR. RAY

In his 18 years as a podiatrist, Dr. Ray McClanahan has learned that most foot problems can be corr...
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