The Center for Podiatric Care and Sports Medicine

Achilles Tendon Injuries: Don’t Let It Be Your Weakness

Posted by on Friday, March 27th, 2015

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The Achilles tendon is a bad part of the body for an athlete to injure, as it is crucial to providing enough power for the gait cycle’s push-off phase. Most sports require repetitive jumping and sprinting–actions which are impossible without a strong, well-functioning heel cord connecting the heel bone to the calf muscles. Achilles tendinitis and ruptures are some of the most common issues our NYC doctors treat at The Center for Podiatric Care and Sports Medicine. And while prevalent, it can also be addressed: it is estimated that 70 to 90% of athletes will have a successful comeback following treatment for Achilles tendon issues, while 3-5% end their careers.

Risk Factors for Achilles Tendinitis & Prevention Strategies

According to the British Medical Journalthe following underlying factors contribute to Achilles tendon injuries:

Muscle imbalance: Shortened, tight calf muscles are almost always implicated in Achilles tendon injuries, so your successful rehabilitation will include strength-training and stretching in this area. Pack your workouts with exercises like donkey kicks, glute bridges, and lunges that can strengthen the Achilles-ankle complex and prevent injury.

– Poor flexibility: Flexibility training for the gastrocnemius-soleus complex (the calf muscles) is also essential in helping the tendon absorb and transfer energy during exercise. Try this seated soleus stretching exercise! Another ideal way to work out this part of the body is to participate in yoga several times a week–The Daily Bandha goes into greater detail on how yoga stretches the backs of the legs.

– Overpronation with external rotation: The natural combination of these two biomechanical anomalies produces a “whipping” action in the Achilles tendon and also causes decreased blood supply that contributes to degeneration over time. Excessive pronation also increases stress on the Achilles in the mid-stance phase of running, which leads to trauma over time. A gait analysis at The Center for Podiatric Care and Sports Medicine can identify whether these factors may be present in your gait.

Flat feet: The “cavus foot,” as it’s called, absorbs shock poorly and increases stress on the lateral side of the Achilles tendon. If you have flatfoot, avoid using rigid arch supports. Instead, visit us to obtain 3-D computer scanned custom orthoses shoe inserts that provide better support for your feet. The strength and flexibility exercises already mentioned will be of great benefit to you as well.

Weight: If you’re exercising to try and lose weight, this can be frustrating, but research shows that heavier runners tend to sustain more frequent Achilles tendon injuries than lightweight runners–so take it easy with running until you’re within your ideal BMI range. Losing weight with an Achilles injury is easier than you may think. Through calorie reduction and low-impact exercises like swimming and stationary biking, it is possible to lose 1-2 pounds per week to safely reach your goals.

– Improper footwear: Increased pronation occurs when the shoes do not have sufficient firmness along the inside of the shoe. Also, soles that are too rigid increase stress on the Achilles tendon. Insertional tendinitis and bursitis can be caused by friction from the shoe on the back of the heel. We are always happy to discuss shoe choice with our patients, as the simple decisions we make as consumers can prevent a vast number of foot problems.

Am I Just Sore, or Did I Hurt My Achilles Tendon?

Symptoms of an acute Achilles tendon rupture may include:

– Sudden stabbing pain in the back of the ankle or calf that often subsides to a dull ache

-A popping or snapping sound

– Swelling between the heel and calf

– Difficulty walking up stairs and uphill or rising up on toes

Symptoms of chronic Achilles tendonitis may include:

– Pain and stiffness in the heel, especially in the morning or after activity

– The most severe pain the day after exercising

– Swelling that is present all day, especially after prolonged activity.

Conservative Treatments

Most people suffering from Achilles tendinitis do respond to conservative treatments like anti-inflammatory drugs, stretches, heel lifts for the shoes, night splints, arch supports, and physical therapy. The next line of treatment includes casting or bracing for immobilization. To increase blood supply to the area, sports medicine doctors may use nitroglycerin patches or high-tech methods like platelet-rich plasma injections or extracorporeal shockwave therapy (modalities we offer here at The Center for Podiatric Care and Sports Medicine!).

Surgical Treatment Options

Achilles tendon operations are rare–but, if need be, our board-certified surgeons are adept at:

– Removing degenerated parts of the tendon
– Removing chronically inflamed bursa
– Removing tendon-irritating bone
– Lengthening the tendon by transferring other tendons from the ankle
– Suturing the tendon to re-attach the heel bone

Surgery should be approached with caution, as Deadspin journalist Kyle Wagner duly notes. He explains: “Patients are typically rushed into surgery relatively quickly to keep the ends of the tendon from shortening, which would reduce range of motion and the ability to store energy.” Obviously, changes to a person’s physiology that would loss of mobility is a major concern!

However, Wagner also warns, “Surgery poses the risk of over-elongating the tendon, though, which could also severely impair functionality.” Meeting with a knowledgeable surgeon who can diagnose and evaluate your condition is the best way to know for sure if surgery will help or hinder you.

Achilles Tendon Rehabilitation in NYC

The Center for Podiatric Care and Sports Medicine is fully equipped to handle all types of Achilles tendon injuries–whether acute or chronic. Our board-certified podiatric surgeons can repair degeneration and tears. We can also treat pain related to inflammation or structural damage, using the latest therapies along with conventional physical therapy sessions. Our NYC athletic trainers are all medical doctors experienced in working with professional-level athletes and runners. Contact us to book an appointment without delay to prevent worsening of symptoms.

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If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.