One of the few times I will ever tell a patient to wear their high heels is when they complain of Achilles tendon pain. I say this in jest but in all seriousness the height of the heel does relieve tension on the Achilles tendon and therefore may decrease symptoms.
The Achilles tendon is the largest tendon in the human body. It connects the back leg muscles to the heel bone and can withstand a very large amount of stress. The repeated stress that we place on the Achilles tendon can sometimes cause pain and swelling to the back of our heel which may inhibit our ability to walk. Some have pain at the insertion of the achilles tendon and others may have the pain higher up away from the insertion. Both types of tendonitis are common and are a result of damaged tendon that is inflamed and sometimes calcified (hardened) resulting in a painful bone spur. Quite often I have seen a bone spur that has fractured off of the heel bone and now is moving within the tendon every time the patient moves their ankle. This posterior heel spur that is now fragmented off can be extremely painful and typically requires surgery to improve symptoms.
The most common symptoms are pain and stiffness along the Achilles tendon especially in the morning, pain along the back of the heel that worsens with activity, severe pain after exercising, thickening of the tendon, bone spurs, and swelling at the back of the heel that often becomes worse towards the end of the day.
If the pain is at a high level I will typically recommend to the patient to start R.I.C.E therapy. (Rest Ice Compression Elevation). A boot, with a heel lift, will be given to the patient and will provide pneumatic compression to the Achilles tendon. This compression will help to keep the swelling down and provide stability to the ankle when walking. I will also tell the patient to ice the area frequently throughout the day and to elevate the affected limb above the level of their heart. This drastic elevation of the leg insures that gravity is truly being utilized to decrease the inflammation to the leg. I may also prescribe or suggest taking an oral anti-inflammatory to help control symptoms. This RICE therapy will continue for 3 weeks and typically the pain will greatly improve. If not, then an MRI will be ordered to ensure that there was not a rupture or tear of the tendon.
The next step is to ensure that the patient continues to support the tendon with some type of brace in order to ensure proper healing. An ankle foot orthoses (AFO) is used to do just that. It limits the range of motion of the ankle and slightly elevates the heel to relieve tension off of the achilles tendon. This AFO will be used for 2-3 weeks until symptoms are minimal. After achieving an almost pain free tendon, the patient will typically be fitted for a pair of custom orthotics (custom inserts). The reason why we utilize orthotics is because a major cause of achilles tendonitis is overuse. When we walk we we tend to flatten our arches thus increasing tension on the achilles tendon. So, the supporting nature of the orthotic to the arch decreases overuse of the achilles tendon by stopping the abnormal flattening that patient’s will frequently exhibit. The custom orthotics are far superior to any prefabricated or store bought insert and are also a better investment. The lifespan of our orthotics are typically 5-10 years and are completely modifiable to adjust with your changing body.
Achilles tendonitis is a very painful and debilitating condition but can be conservatively treated. We at Advanced Podiatry want to provide the most effective and efficient treatments for all conditions and our conservative protocol for achilles tendonitis achieves excellent results. Call today, 813-875-0555 to make an appointment and get rid of your Achilles tendon pain immediately.
Dr. Jairo Cruz Jr