Achilles Tendonitis

low-level laser acupuncture The achilles tendon (the heel cord), is a large tendon that is an extension of the two largest calf muscles. It travels down the back of the lower leg and attaches to the heel bone. The achilles tendon transmits the strong forces of the large gastrocnemius/soleus muscle group at the back of the calf from the lower leg to the foot.

Most injuries of the achilles tendon do not result from recent acute injury, but as stated above, develop gradually over weeks or months. These are "overuse" or "misuse" conditions caused by excessive and/or repetitive motion, often associated with poor biomechanics. The end result is a microtrauma injury: The body is unable to keep up with the repair and re-strengthening needs, so the tissue begins to fail and becomes symptomatic. If it is not very painful (or when the pain is eliminated by medication), continued stress eventually can lead to complete failure, with a resulting acute tear of the tendon.

Rehabilitation of the Achilles Tendon

Despite the origin, if you are experiencing achilles tendonitis symptoms, it is vital for you to see a qualified professional. Conditions such as tendinitis and tears of this tendon require appropriate rehabilitation to prevent continuing problems and disability. Dr. Pisarek is a highly-skilled professional who can help you to manage the ailment before it becomes severe.

With acute injury an initial period of relative rest is needed. Occasionally, the weakened tissues will tear through, resulting in a ruptured achilles tendon. This may require surgical repair and a period of rest before rehabilitation can begin. During this period, however, exercise of the opposite ankle should be encouraged. Vigorous exercise of the uninvolved contralateral ankle muscles produces a neurological stimulus in the injured muscles (the "crossover effect"), and helps to prevent atrophy. Initial treatment also should include heel lifts to reduce the strain on the Achilles tendon, and crossfiber friction to improve circulation.

Complete return to function will require attention to range of motion, functional strength and orthotics (orthotic support)...

  • Range of motion: In addition to appropriate foot and ankle adjustments, stretching of the tight and shortened gastrocnemius/soleus muscle complex is a necessary part of achilles tendon rehabilitation. Gentle stretching should be started early, putting a linear stress on the tendons and stimulating connective tissue repair. The standard is the "runner's stretch," performed against a wall. Patients with tightness and pronation will often allow the foot to flare outward while stretching, which forces the medial arch to drop. This tendency must be carefully corrected, with the foot positioned straight ahead and the medial arch kept elevated. It is even better for the patient to perform the stretches with corrective orthotics in place.
  • Functional strength: Isotonic strengthening exercises that focus on the eccentric (negative) component have been shown to improve the healing of tendons and accelerate return to sports participation. These exercises should be progressed to closed-chain, heavily loaded eccentric exercises to stimulate collagen fiber re-orientation and strengthening. One example of these exercises requires that the patient sit on the edge of a stair, perform a toe raise-up, then rapidly drop the involved heel as far as possible, returning by pushing back up with the uninvolved leg.
  • Orthotics (Orthotic support): A shoe insert made with shock-absorbing material will help decrease the amount of stress on the feet, legs, and back during running. Orthotics have been found to be quite useful in the long-term improvement of running biomechanics. While there is still controversy regarding exactly how and why orthotics are so useful, there is solid empirical evidence of their benefits to runners, both for treatment and prevention of overuse injuries. As described above, most achilles tendon problems develop from poor foot and ankle biomechanics, and control of pronation is needed to prevent recurrent injuries. Custom-made, flexible orthotics are now available that can support the hindfoot, midfoot and forefoot, thereby providing biomechanical control throughout the entire gait cycle.

Physiotherapy and Laser

At Advanced Healthcare, Dr. Pisarek has successfully used various physiotherapeutic modalities such as: kinesiology tape, ice, heat, ultrasound and interferrential currents in the management of achilles tendinitis, providing there were no contraindications to treatment present.  Over the past few years, Dr. Pisarek has also found that the application of low level laser therapy (LLLT) has shown to be very effective in reducing the pain and inflammation of tendinitis, and, appears to promote healing. Laser therapy for tendinitis may reduce the need for surgery and cut the healing time for tendinitis by as much as 50%.

The photons from the laser beam stimulate the cells of the damaged tissues increasing cellular reproduction and growth, increased blood flow and oxygen supply to the tissues thereby promoting faster tissue regeneration with wound healing and minimizing scar tissue formation. Laser therapy for tendinitis is also said to promote nerve cell regeneration.

If left untreated, tendonitis could become chronic and lead to a rupture (or tear) of the tendon, which would then require surgery. Even after surgery, permanent damage may not be avoided. So it's best to get any symptoms you may have of tendonitis checked out as soon as they arise.

Conclusion:

Achilles tendon injuries can be successfully rehabilitated conservatively with hands-on treatment. Steroid injections and casting are seldom used these days. Once the local inflammation has been controlled, improved blood flow to the region of relative avascularity is necessary. Chiropractic joint mobilization techniques, correct stretching and strengthening exercises can be demonstrated and monitored in Dr. Pisarek's office. One of the most important long-term goals is to reduce any tendency to pronate excessively. In addition to custom-made orthotics (Footmaxx) , all runners should be encouraged to wear well-designed shoes that provide good heel stability with a small amount of additional heel lift. This helps prevent achilles tendon problems, and is especially important in athletes who run more than a few miles at a time.

Prevention of Achilles Injuries:

Prevention of achilles tendonitis can be achieved with slowly increasing activity, purchasing quality foot wear, stretching, and cross-training. People who have had a history of achilles problems need to be conservative with their exercise and training programs. Big problems and injuries to the achilles tendon occur most commonly after ignoring small problems and pains. Pain is a warning sign something is wrong. Ignoring the problem often creates a more extensive injury.

Prevent small achilles injuries from becoming large injuries that may require

more time and treatment to correct. Call Dr. Pisarek today for an appointment at (416) 633-3000!

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