Achilles Tendonitis
Achilles tendonitis/tendonosis is one of the most common conditions we see in our clinics. Patients describe pain and sometimes swelling in either the mid part of the tendon and /or at the attachment point of the tendon on the back of the heel bone. Achilles tendonosis is often painful, prevents exercise and often interferes with completion of day-to-day activities. Most patients describe a gradual onset of symptoms with pain localised in the mid tendon and painful to touch/squeeze. During walking, the pain is felt in the ‘toe-off’ phase of the gait cycle when the heel lifts off the ground just before the leg swings through. This condition has multiple causes, but the underlying issue is the inability of the tendon fibres to cope with the load placed upon them.
The condition can occur in people of all ages and lifestyles and is common in people commencing walking/running, or any sport following a long period of inactivity. In addition we see Achilles tendon issues in athletes who are increasing their volume or intensity of exercise, perhaps ramping up for a future event.
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How to treat Achilles Tendonitis
It’s important to take a detailed history and identify the mechanisms of injury. Like most tendon injuries, rest, exercise modification, cross training and a team approach to treatment is crucial to tendon healing and a return to exercise. It’s important that we understand the patient’s goals on their rehabilitation journey as this will guide the treatment process.
Following assessment, your podiatrist will work with you in implementing a personalised treatment plan which suits your goals and rehabilitation needs. The usual course of treatment will include the following:
- Rest, exercise modification/cross training
- Strengthening exercises (eccentric loading program)
- Footwear changes/ recommendations
- Taping/kinesio tape
- Shockwave therapy
- Customised orthotics - changes loads on the tendon and improves mechanical deficiencies
Calf Strain
A calf tear or strain is a tear to the muscle fibres that make up one of the muscles in the back of the lower leg. The calf group consists of the gastrocnemius (large muscle consisting of two heads), and the soleus (lies under the gastrocnemius muscle). Both muscles combine into a common tendon called the Achilles tendon which inserts into the back of the heel bone. The action of the calf muscle is to plantarflex the ankle joint (lift the heel off the ground – standing on tip toes is plantar flexing the ankle).
A mild calf strain can feel like a cramp or dull ache in the calf muscle, usually the large part on the medial (inside) area of the leg. This is usually felt during exercise after sudden efforts like sprinting or change of direction activities. The pain with a mild calf strain may not be enough to stop exercise but is usually worse after cooling down and getting back on your feet. A grade 2-3 ‘tear’ of the muscle fibres will feel like a severe cramp with sudden on-set of pain and usually limits further physical exercise. Some patients develop noticeable swelling and bruising. These people should seek an expert opinion/diagnosis particularly if symptoms are felt lower down in the calf/achilles area of the leg.
How to treat a calf tear
In the early stages it is important to seek an expert opinion and diagnose the problem accordingly. Left untreated, calf tears can be problematic and often reoccur if the site/severity of the tear is not first identified and the correct management put in place. Rest, compression (tube bandage) and pain management (ice, NSAIDS- ibuprofen) is recommended during the acute phase of the injury followed by massage, dry needling, and strengthening/stretching and other rehab exercises.
A biomechanical examination is helpful, particularly when the injury is reoccurring. Core stability issues and foot mechanics issues can be a factor in re-injury and easily rectified.
