‘Treatment of Frustrating Heel Pain – Achilles Tendinopathy?’
This week I will discuss treatment and management of Achilles pain. Two factors that can lead to no improvement and indeed worsening of symptoms include overloading the tendon, such as running and training on the tendon when the achilles tendon is not yet strong to take this load pressure. The second factor is wrong diagnosis. Achilles Tendon pain can be caused by 10 or more conditions. For example Achilles Peritendinitis which is inflammation of the peri-tendon sheath that covers the Achilles tendon needs to be treated with anti-inflammatory gel or hirudoid cream as opposed to a load strengthening program.
Early stage Achilles Tendinopathy Treatment & Management
Achilles tendinopathy needs to be treated by reducing the aggravating activity such as road running, training or walking, within a non-painful zone. So if walking 1 km is not causing pain but there is pain walking 2km, then walk 1km every 2nd day, again this would be advised by your Physical Therapist. Achilles Tendinopathy is divided into 2 areas, Insertional Tendinopathy and mid tendon Tendinopathy. Insertional Tendinopathy occurs at the insertional point of the tendon to the calcaneal bone and Mid-tendon tendinopathy occurs 2cm higher up from the calcaneal bone tendon attachment point. This is important in terms of commencing the exercise Loading Rehabilitation program. For example during the early isometric exercise stage, Mid-tendon Achilles tendinopathy is carried out with the heel 1-2cm off the floor where as Insertional Achilles tendinopathy is carried out with the heel 3/4 of heel-lift (greater than 2cm) range off the floor. This Heel raise isometric exercise is held for 40-60 seconds x 4 repetitions x performed 4-6 times per day. All loading programs involve progressing to greater load exercise without pain and in this early stage, the progression would be moving from double leg constant heel raise to single leg constant heel raise, again without pain.
Running and Achilles Pain
When a road Runner or a Sports Player experiences Achilles pain it is commonly caused by an overextending running technique. This means that the athlete’s heel strikes the ground, with the knee commonly extended or straight and the foot is in front of their center of gravity which is the navel or belly button. This in an inefficient running technique causing poor shock absorption, causing more effort and load when pushing off the heel. The correct technique involves a bent knee with the point of heel strike directly under the center of gravity of the body, the navel (bellybutton).
Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy (MIAPT) and is based in Thurles.
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