For most people, if they are asked to name one tendon in their body, it would be the one at the back of the heel – the Achilles tendon. The name comes from Greek mythology, where Achilleus, the greatest of all the Greek warriors and hero of the Trojan War, was known for one weakness – his heel. Apparently, this was where his mother held him as she dipped her infant child in the river Styx so that he was invulnerable. That specific part of his body wasn’t blessed like the rest of him, hence the term “Achilles heel”, meaning a point of weakness, especially in someone or something generally strong.
Interestingly, your Achilles tendon is the strongest tendon in your body. It connects the calf muscles to the heel bone and enables us to thrust ourselves upwards for walking, running, dancing, jumping etc. When it becomes irritated or inflamed, it can mean that every step or movement taken can be painful. It can also take a long time to resolve as its blood supply isn’t the best, and the tendon is used so frequently that it is constantly being re-irritated.
For those who have been following the series of articles on how to cure various foot problems, this particular one is similar in content to the one about plantar fasciitis (heel pain). In both cases, accurate diagnosis is key to successful treatment plans, as there are other conditions that can affect the tendon and surrounding tissues. These include tendonosis (tendinosis), paratenon problems, micro or macro tears, Kager’s fat pad inflammation, retrocalcaneal bursitis, Haglund’s deformity, and many others.
However, let’s assume that the diagnosis is correct, and it is indeed your Achilles tendon that is inflamed, hence the term “itis”. Commonly, this inflammation can occur either at the insertion of the tendon into the heel bone (calcaneus), which is known as “insertional”,; or it can occur in the main body of the tendon, which is known as ”mid-portion”. A good Podiatrist is able to carry out in-depth assessments to provide an accurate diagnosis and develop an individualised treatment plan to help resolve the problem.
The tendon becomes inflamed predominantly due to a spike in load that irritates the tissue. This can be as simple as from a new pair of shoes, digging in the garden, climbing ladders, or going for a longer walk or run than normal. Once irritated, the inflammation can spread to the heel bone itself, causing bone oedema (swelling). The classic pattern with Achilles tendonitis is that it causes pain on initial weight bearing after rest and then gradually eases with use.
How can Achilles tendinitis be cured?
Well actually, all we have to do is provide the optimal conditions for the body to heal itself. However, that is more difficult than it sounds. Many of our body tissues have a zone of optimal stress (ZOOS) which enables them to function well without causing symptoms or problems. If we cause a spike of load to our tissues, then they are pushed out of their ZOOS, and they become inflamed & damaged. If we don’t put enough load through them, then weakness and degeneration can occur. As we get older and also associated with certain common medical conditions (such as diabetes), our ZOOS becomes reduced so it’s easier to be outside of the zone in the regions where problems occur. The key to resolving Achilles tendinitis is identifying a patient’s ZOOS (which will be different for each individual), then keeping the tissues within that so that self-repair takes place and expanding their ZOOS over time to help avoid recurrence of the problem. Different patients will have differing requirements to keep them in their ZOOS, but a common treatment plan at my clinic is:
Occasionally we may have to add in additional therapies such as shockwave therapy, high-intensity laser therapy, steroid or hyaluronic acid injections, bespoke orthotics, or mobilisations/manipulations. By having so many tools in our toolbox, my clinic has a great reputation for helping to resolve Achilles problems.
But don’t just take my word for it – here is one of the many 5-star reviews we receive:
“Specialist advice from a highly skilled and knowledgeable professional – bridging the gap between podiatry and physio for successful outcomes of foot issues.”
If you require an appointment to help you, please call 01926 811272 or book online at www.healthfirstsoutham.co.uk/book-appointment.
Jonathan Small, Lead Podiatrist, Health First Foot & Gait Clinic, Southam, Warwickshire, 01926 811272