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Achilles Tendon Heel Pain: How to Avoid it and What are Your Best Treatment Options.

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Treating the root of the problem for an achilles tendon injury

achilles tendonitisThe Achilles tendon originates from the large calf muscles in the back of the lower leg and attaches to the back of the heel bone. Its function is to push your heel up off the ground and to propel you forward. Pain can occur along the tendon, that band of tissue just below the calf muscle, or where the tendon attaches to the heel bone. The pain can be very disabling, not allowing you to walk or run anymore and or do other activities. It may limit the range of motion in your ankle because of the pain. You may also notice swelling of the tendon associated with your pain. If the back of the heel bone appears enlarged, it may be from the Achilles tendon. So even though a heel spur or boney growth on the back of the heel may be noted it is now thought that in many cases the pain is from the tendon. These problems are referred to as a Haglund’s deformity or a retrocalcaneal spur. This goes against much of conventional medicine as our approach but the high success rate of our treatments for an achilles tendon injury that are directed at treating the tendon and not the bone prove otherwise.

Diagnosis

The diagnosis of achilles tendon injury and heel pain is usually made by the doctor’s clinical exam. However, diagnostic ultrasound or MRI may also be used for a more accurate evaluation.

Causes

  • Overuse – This is a common cause for injuries sustained to the achilles tendon. If you overdo it without gradually increasing the activity so your body has time to recover this can be a problem.
  • Types of activities – Some activities may make you more susceptible to achilles injury and heel pain. This would include running up and down hills, or any activity where impact or jumping is involved.
  • Age – As we get older it is thought that the tendon can become weaker. When this happens the tendon gradually starts breaking down.
  • Foot type – Improper foot structure and biomechanics may also play a role. An example is a foot that over pronates, flattens, which may cause more pulling on the tendon. A high arch foot may allow the heel bone to rub against the Achilles tendon.
  • Weight – Excessive weight can put excessive load and stress on the tendon.

Prevention

  • Shoe gear – Avoid wearing shoes when your active that are broken down. The lack of support may lead to heel pain or Achilles’ tendonitis.
  • Heel lifts – If your just beginning to experience pain using a heel lift can take some of the stress off the tendon.
  • Changing activities – Consider backing off activities or changing the activity to one that puts less demand on the tendon.
  • Stretching – This may also be important both before and especially after activity.
  • Anti-inflammatories – taking anti-inflammatories short term may also be useful but long-term use should be avoided as they may have a negative effect on your bodies natural healing processes.

achilles tendonitis exercises

Treatments

Treatments that your doctor may recommend can include resting the area and sometimes immobilizing the area in a walking boot. Physical therapy along with heel pain stretches may also be considered. Also, anti-inflammatories may also be suggested. These treatments can work in the early stages but if the problem is more severe or chronic maybe band aid approaches.

The top four treatments we offer that get at the root cause of the problem. It may not be tendonitis!

  • Regenerative medicine – new terminology Achilles TENDONOSIS
    The use of stem cell treatments for over the past decade have proven to be phenomenally successful. The new way of thinking about the Achilles tendon and heel pain is that the problem has more to do with the tendon breaking down and having small, microscopic tears then being inflamed. This is called tendinosis. That is why the use of regenerative medicine make more sense. It’s used to repair damaged tissue rather than treat inflammation which may not be present.
  • Orthotics – The myth of the tight Achilles tendon
    Orthotics are commonly used and have a high success rate, why? We know that with every step you take your heel bone rolls from side to side. This motion is thought to put more pulling on the tendon along its length and where it attaches to the heel bone. A custom made orthotic greatly reduces this motion and often eliminates the problem. This goes against the conventional thought. Yes, the pain can be from a tight Achilles but from our experience its less likely than previously thought.
  • Shockwave – Shockwave is also a treatment that has been successful. Shockwave is similar lithotripsy where sound waves are used to break up kidney stones. This type of treatment sends powerful sound waves in the Achilles tendon area and traumatizes the tendon, but this stimulates your body to send more cellular components to the area that help repair the tendon. This has also shown quite significant relief for patients with this issue.
  • Accelerated Laser Pain Therapy – Laser works on a cellular level helping the mitochondria of the tendon tissue repair the tendon. The mitochondria is the area of each cell that creates energy and is responsible for cellular repair.

If the above options fail, surgery may be considered to treat the injury.

Surgery can also be effective but is exceedingly rare as the approach we with orthotics, regenerative medicine, shockwave and laser as options is highly successful at getting you back to full activity.

So if you find yourself dealing with this, understand that you can start out by treating on your own by the suggestions offered in this blog. But the longer this goes on, it’s more important to seek professional attention to ensure that you’re having this treated aggressively. There is a solution for your Achilles tendon heel pain. It’s important that you have consultation with somebody that is proficient providing the treatments we’ve recommended for injuries of this type. If your getting nowhere and feeling frustrated with your present situation please feel free to contact and we’ll help you to evaluate if our approach is appropriate for you.

CJ’s Story: Chronic Tendon Pain (The Power of Regenerative Medicine)

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CJs testimonials chronic tendon pain

The new year is here, and for many of us that means it’s time to focus on our health, and address some of those lingering issues we’ve been putting off.

Today, I will share a success story of a patient who was dealing with chronic joint and tendon pain for several years. My goal is to help instill hope in many of you who have been experiencing similar pain, and have perhaps given up on finding a solution. So, here we go.

52, Healthy and Active

This patient is a 52 year-old female, who was healthy and active. We will call her CJ. She came into my office with a variety of foot complaints. The primary issue was chronic joint and tendon pain in her right foot and ankle, and this had been going on for several years.

Seven years prior, a horse stepped on her foot and she was diagnosed with a “hairline fracture” and wore a cast for three months. Once she was out of the cast, she could get back to activity with little pain. However, over the next five to six years, she started having more and more pain in the area that began to significantly limit her activity. This gradually led to weight gain, which only made the problem worse.

Plantar Fasciitis, Arthritis and Tendon Pain

When I first saw CJ, she was planning on having gastric bypass surgery, but was concerned that she would not be able to exercise properly after the surgery because of her foot and ankle pain. She had previously been treated for plantar fasciitis by another doctor.  She had steroid injections and wore a night splint, but neither treatment seemed to give her any relief.

During her initial exam, her X-rays showed that the old injury had been more than just a hairline fracture. She had evidence of post-fracture arthritis in two joints in the middle of her foot. The fracture had healed, but left joint damage behind. Her other main issue of ankle pain was diagnosed as a partial tendon tear. This had likely been aggravated by compensating for the joint pain.

Regenerative Medicine + Surgery

Many times, when patients present with arthritis, tendon pain, or plantar fasciitis, we use regenerative medicine therapy to help stimulate healing and avoid surgery altogether. But, in CJ’s case, we needed to use several different treatments to help address all the issues that had been accumulating for all these years.

We performed surgery to repair the tendon tear and used regenerative injections to help heal the joint damage. To better support the damaged joints, we fitted her for custom orthotics. She then began physical therapy to improve her strength, balance, and flexibility.

Ten Weeks Later

CJ was on crutches for four weeks after the tendon repair. But, once we cleared her to start walking, she progressed quickly. She was highly motivated and committed to her therapy and post-operative rehab. Ten weeks after surgery and regenerative therapy, she was already back to walking and elliptical workouts daily. She still has the occasional sore muscles, but no longer has anywhere near the pain she did before. CJ is still considering gastric bypass surgery. But, she now feels she will be able to lose the weight without it since she can exercise without pain.

So, if you or someone you love is struggling with daily foot or ankle pain, please don’t wait any longer to address it. Call today to make an appointment, and we can discuss treatment options with you.

2018 can be your last year to deal with chronic pain. It’s time to get on the path to healing, together.

Chronic Foot Pain: Why Am I Still in Pain?

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It’s never fun to suffer an injury of any kind. There is always the initial pain and limitations. But, what happens when the pain doesn’t go away even when the injury is “healed?”

Does it just need more time? Are you doing something wrong? In many cases, the injuries look completely healed on X-rays or MRI, but the pain continues. So what do you do next?

I’d like to tell you a story about a patient who had just this problem. We will call her Alice.

The Ankle Fracture that “Healed”

Alice is a 32 year-old female patient. She came to see me for severe daily pain in her foot and ankle, which initially started after she fractured her ankle. Alice fell on her ankle and heard/felt a pop. She was evaluated in the ER and properly diagnosed, and subsequently had surgery to repair the fracture. The repair went as planned and after six weeks her X-rays showed a completely healed fracture.

She was then allowed to start walking on it again. That was when her pain really started. After surgery, she had experienced the normal post-op pain, but it wasn’t until she was out of a cast that she began having constant ankle and foot pain that was not relieved by much of anything. It hurt when she walked and it hurt when she didn’t walk. The pain woke her up and kept her awake.

Time to Put on My Detective Hat

Alice was at the end of her rope, and was even considering possible amputation if the pain could not be relieved. With any patient in this much pain, my first impulse was to throw the kitchen sink at her problem to try to find some way of getting her relief. However, in order to help these patients, I know I have to put on my detective hat, do a thorough review of their injury, treatment, and health history, and then put together a step-by-step plan to hone in on the primary cause of the pain.

A Painful Scar

Alice had pain throughout her foot and ankle, but the majority of the constant pain was along the inside of the ankle and down into the foot. This area was so sensitive that any light touch would send pain up and down her leg. She was especially sensitive along a surgical scar from her ankle fracture repair.

She had mentioned this to the surgeon who fixed her ankle and he assumed it was simply a painful scar and would improve with time but instead the pain grew steadily worse. An X-ray showed the screws and plates in the bones did not appear to be causing any problem and the scar itself did not appear thickened or contracted. However, the location of the incision was right over one of the main nerves in the leg, and I considered the possibility that the nerve had been damaged or cut during the fracture repair.

Testing the Theory

A simple way to test this theory was to perform a diagnostic nerve block of the nerve higher up the leg with a long-acting local anesthetic and a small amount of steroid. This will decrease inflammation and reduce sensitivity of the nerve for 2-3 days after the injection.

If the patient’s symptoms significantly improve for a few days after the injection, then it is a good bet that the nerve itself is the source of the pain and not just the messenger. If it only feels better while it is numb, then it’s time to head back to the drawing board. Alice had significant improvement for 3-4 days after the block before the pain returned. This is normal and expected because you can only use this injection for diagnosis, not treatment.

The Source of the Pain

Once we knew the nerve was the source of her pain, it was time for treatment. In this case, I recommended a procedure called a neurectomy of the nerve. This involves making a small incision over the nerve, farther up the leg than the damaged portion. I then locate the nerve, and cut it to shut off the pain signals. It’s kind of like throwing a breaker on an electrical outlet.

Although this might sound drastic, it is a much safer and effective option than other chronic pain management options (opiates or a spinal stimulator for example). For Alice, it worked very well. Once the nerve pain was eliminated, she was finally able to participate in physical therapy to address the other tendon pain and weakness that had developed from how she was compensating for the pain.

Finally, Pain Free

At Alice’s last follow up, she was pain free. She still had a bit of residual limp that will continue to improve with therapy. I present Alice’s story as an example of the complex diagnostic work-up often involved with post-traumatic chronic pain.

No two patients are the same and no two injuries are the same. What worked on one may not work on the other. As a doctor, when I see patients with chronic pain, I have two goals in mind.

1. Identify the primary problem.

2. Do not aggravate the pain any further with unnecessary treatments.

Once we identify the root of the issue, we can then proceed with the appropriate treatment to relieve the patient’s pain.

If you are experiencing chronic injuries or unresolved pain, please come see us! We can help. Come visit your podiatrist in Fort Collins or Broomfield for further consultation.

To learn more about our treatment options, click here.

Book your appointment here. 

Why Treadmill Running on an Incline is a Bad Idea

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I treat a wide variety of sports-related aches, pains, and injuries involving the feet and ankles. While there is no sure fire way to avoid all of these issues, there are some common workout methods that can aggravate your feet more than others. Over the years, I have learned to ask for detailed info on a patient’s exercise regimen. For example, the type of running shoes, hiking boots, etc they use is important. The type of surface they are running/walking on, warm up and cool down techniques, etc. are all very important.

This advice does not pertain to everyone or every situation. If you do any of these things and don’t have pain, then feel free to keep doing what you are doing. But, if you have been dealing with nagging foot pain that isn’t going away, then read on. A simple change in how you exercise may help.

1. Treadmill Running + Incline = Pain

This is one I have seen quite frequently. Just running on a treadmill is fine in most cases. But, once you start cranking up that incline, the chances of pain and injury also start to climb.  As the pitch increases, you start running more on just the ball of your foot. This does three things.

  1. Focuses all the impact on just the ball of the foot.
  2. Prevents normal rear-foot pronation which leads to decreased shock absorption to the whole foot.
  3. Causes increased tension/strain on the Achilles tendon and maintains this strain throughout the stride.

These things can lead to development or worsening of neuroma pain, plantar fascia pain, Achilles tendonitis, and joint pain in the ball of the foot. So if you routinely use the treadmill on an incline, and have been having any type of foot pain, keep the treadmill flat or run outside or on a track if possible.  This may not solve the problem right away, but can be a good starting point.

2. Barefoot + Running = no problem (most of the time)

BUT:  Barefoot + Dance/Aerobics/Zumba/etc = Ouch

For many years now barefoot running has been touted as good for your feet and for many people this can be true.  However, just because barefoot running may have some benefits, it doesn’t mean that being barefoot during other types of workouts is just the same. For example, dance-type aerobic workouts like Zumba are very popular, and can be a great workout, as well as a lot of fun. But these types of activities (usually done on hard surfaces) involve quite a bit of repetitive stress and impact on the feet and should rarely, if ever, be done barefoot. A decent pair of athletic shoes will provide the necessary shock absorption and support to keep your feet happy and healthy.

3. Beware of the “Minimalist” Shoes

Over the past few years, “minimalist” shoes have been popular and are marketed as having similar benefits as barefoot-type shoes. These minimalist shoes are typically very lightweight, flexible and offer little benefit for either support or shock absorption. In addition, since the foot’s motion is still confined in a shoe, they do not have the foot strengthening benefits of barefoot shoes.  In short, they provide all of the negatives of barefoot running and none of the positives. Stiffer soled shoes with adequate cushion are usually the better option if you are having any chronic foot pain.

As I mentioned before, these recommendations do not pertain to every person in every instance. However, if you regularly do any sort of these workouts and have any foot pain associated with it, then it may be a good idea to make some minor adjustments to your routine. Your feet will thank you for years to come.

If you are experiencing unresolved  foot pain, come see us! We can help.

Book your appointment here.