It may start when you get out of bed and notice that walking across the floor is suddenly painful. It’s an aching, burning sensation in your heel area and it won’t go away. You may have Achilles tendinitis.
Achilles tendinitis is common in younger people. Symptoms start gradually and spontaneously, especially with morning activity. It may improve slightly at first, but it is aggravated by exercise. The Achilles tendon is often enlarged, warm and tender.
A condition called Tendinosis is similar, but typically afflicts middle-aged people.
Severe pain and limited walking ability may indicate a partial tear of the tendon. The Achilles tendon is the largest tendon in the body. It is formed by the merging together of the upper calf muscles and inserts into the back of the heel bone.
WHAT CAUSES ACHILLES TENDINITIS?
The cause of Achilles tendinitis or “paratenonitis” is not well understood, although there is a correlation with a recent increase in the intensity of running or jumping workouts, explains Dr. Zachary A. Zobens, foot and ankle surgeon with The Foot and Ankle Center, who has offices at 7345 Watson Road, 11066 Olive Blvd. in Creve Coeur and at 2013 Johnson Road, Suite A, in Granite City, IL. The Foot and Ankle Center has a total of eight locations in Missouri and Illinois.
Achilles tendinitis can be associated with repetitive activities which overload the tendon, posture problems such as flat feet or high-arches, or footwear and training issues such as running on uneven or excessively hard ground or running on slanted surfaces, Dr. Zobens said. Tendinosis is also associated with aging.
The tendon’s blood supply comes from the muscles above and the bony attachment below. The blood supply is limited at the “watershed” zone approximately one-to-four inches above the insertion into the heel bone. Paratendonitis and tendinosis develop in the same area.
HOW IS ACHILLES TENDINITIS DIAGNOSED?
There is enlargement and warmth of the tendon. Pain and sometimes a scratching feeling may be created by gently squeezing the tendon between the thumb and forefinger during ankle motion. There may be weakness in push-off strength with walking. Magnetic resonance imaging (MRI) can define the extent of degeneration, the degree to which the tendon sheath is involved and the presence of other problems in this area, but the diagnosis is mostly clinical.
TREATMENT OPTIONS
“A majority of my patients respond very well to conservative therapies including stretching, icing, orthotic and cortisone injections,” said Dr. Zobens. “For those that need a more aggressive approach, we offer laser therapy, shockwave therapy, PRP and stem cell injections, as well as surgical options for the very small percentage of people that require it. Our offices also have x-ray availability on-site, as well as an extremity MRI machine if advanced imaging is necessary.”
Most cases are successfully treated non-surgically although this is time-consuming and frustrating for active patients, according to The Foot and Ankle Center. Treatment is less likely to be successful if symptoms have been present more than six months. Nonsurgical management includes nonsteroidal anti-inflammatory medications, rest, immobilization, limitation of activity, ice, contrast baths, stretching and heel lifts.
If symptoms fail to resolve after two to three months, a formal physical therapy program like those administered by The Foot and Ankle Center may be of benefit. An arch support may help if there is an associated flat foot. A cast or brace to completely rest this area may be necessary.
MORE INFORMATION
For more information about The Foot and Ankle Center, call 314-487-9300 or visit www.facstl.com for office locations and hours.
Other foot problems
A podiatrist, also called a doctor of podiatric medicine, is a specialist who provides medical diagnosis and treatment of foot and ankle problems, such as bunions, heel pain, spurs, hammertoes, neuromas, ingrown toenails, warts, corns and calluses. A podiatrist also renders care of sprains, fractures, infections, and injuries of the foot, ankle and heel.
In addition to undergraduate medical school training, podiatrists also attend graduate school for a doctorate in podiatry. Podiatrists are required to take state and national exams, as well as be licensed by the states in which they practice.
Podiatrists at The Foot and Ankle Center treat a variety of problems including:
- Issues of improper footwear, physical stress, or small mechanical changes within the foot
- Arthritic foot problems, which typically involve one or more joints
- Congenital foot problems, which occur at birth and are generally inherited
- Infectious foot problems, which are caused by bacterial, viral, or fungal problems
- Neoplastic disorders, also known as tumors, which are the result of abnormal growth of tissue anywhere on the foot and may be benign or malignant
- Traumatic foot problems, which are associated with foot and ankle injuries, such as fractures
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