Chronic Achilles Tendonitis

FROM LISA: I learn so much from each of my students…including Dr. Christiane Gardner.

Christiane is a new student and I plan to help her get back into the best shape of her life. Chris has an amazing background… she was a member of the National Cross-Country Championship team for two years in a row, she won the junior national 30km championship in 1978, and more recently she coached Camden Hills Regional Hills School girls XC team from 1999-2004. I feel honored to be coaching Dr. Chris!

In addition to her running talents, Christiane is board certified by the American Board of Podiatric Surgery and the American Board of Podiatric Orthopedics. From 1990-1992, she was the Assistant professor of podiatric sports medicine and biomechanics at the Ohio College of Podiatric Medicine. From 1992-2008, Chris led a private practice in Rockport, Maine. And currently, Chris serves as the Chief of Podiatry Service and Director of Podiatric Medical Education, VA Eastern Kansas Health Care System.

Christiane has offered to talk to any students who are having feet trouble and she has already helped a few! Thank you, thank you!

And here are some thoughts from Christiane about a condition you may have experienced…and ways for you to avoid it.

Chronic Achilles Tendonitis
By Dr. Christiane Gardner

It is estimated that achilles tendonitis accounts for 11% of all running injuries. This percentage increases as the runner ages. If you are reading this, chances are you have suffered from achilles tendonitis.

First, a short anatomy lesson. The achilles tendon is the largest and most vulnerable tendon in the body. It joins the calf muscle (gastrocnemius and soleus) to the heel of the foot. This muscle - tendon complex is responsible for plantarflexion of the foot and is what allows us to propel ourselves forward while running. While tendons are strong, they are not very flexible and they can only go so far before they become inflamed and tear or rupture. Unfortunately, the achilles tendon has poor blood supply which is why it is so slow to heal.



What causes Achilles Tendonitis?

The biggest cause of chronic achilles tendonitis is ignoring early warning signs and pushing through the pain of early achilles tendonitis. If the achilles tendon is sore, you need to pay attention to it immediately!

Other causes include:
· Increasing mileage too soon;
· Excessive hill running;
· Sudden addition of speed work;
· And/or wearing running shoes past their expiration date (see below)

Biomechanically, excessive pronation or flattening of the medial arch can cause achilles tendonitis. When the foot flattens too much or stays flat for too long, the achilles tendon is twisted abnormally. Over time, this twisting can cause microtears in the tendon leading to inflammation and even further damage. Imagine a tight rope where a few fibers begin to unravel and you get the idea. Worn running shoes can also lead to achilles tendon issues for the same reason.

Symptoms

Symptoms of acute achilles tendonitis include:
· Pain of the tendon during exercise
· Swelling of the tendon
· Feeling a "creaking" sensation within the tendon as you move the foot (this is swelling of the tendon sheath).

If acute achilles tendonitis is not treated, chronic achilles tendonitis often follows.

Symptoms of chronic achilles tendonitis include:
· Pain and stiffness in the tendon especially in the morning
· You may feel nodules within the tendon, usually about 2 cm above the heel
· Pain in the tendon especially when climbing stairs or walking up hill

This pain can be a long term persistent problem

Treatment

The best treatment is to listen to your body. If your achilles tendon becomes painful, cut back on your activity, stop running hills and ice, ice, ice! If you can treat this problem early, you reduce the pain and frustration of dealing with chronic achilles tendontis!

Replace your running shoes if they have seen better days.

Place a temporary heel lift in both shoes. This will take the strain off the tendon. Once the tendon is not painful, remove the lifts.

Careful, gentle stretching can help but too much stretching or too aggressive a stretch can contribute to the problem. Please do not stretch your achilles tendon by hanging your heel off a stair. It is difficult to control the stretch, and if the tendon is already inflammed, you may risk tearing the tendon.

Once you have tried the above and are frustrated with your progress, it is time to seek help from a sports injury professional. Physical therapy may be needed to strengthen the calf muscles. Ultrasound and massage therapy may be indicated. New running shoes or orthotics may be needed to reduce pronation.

Please do not allow anyone to inject the achilles tendon with cortisone. Medical literature has many cases of complete achilles tendon ruptures after direct injection of cortisone into the tendon.

Many articles have been written on the beneficial effects of eccentric exercises in the treatment of achilles tendonitis. In this exercise, stand with your hands on a railing or desk for support, using your good leg, rise up on your toes, now put your injured leg down toes first, transfer your weight to the injured leg and SLOWLY lower your body down until your affected foot is flat on the ground. Repeat this 10 times.

In summary, chronic achilles tendonitis can be frustrating and seem to take forever to heal. You can reduce your chances of developing this and other injuries by listening to your body. A few days off in the early stages of an injury can prevent months of seemingly endless rehab!