Your Achilles Heel
A common stubborn injury revealed.
Even the great Greek hero Achilles had one weakness, his heel. Lucky for us, we aren’t dodging deadly poisonous arrows, but we can still have debilitating pain due to this pesky tendon.
Let’s begin with the anatomy. The Achilles tendon attaches your calf to your heel bone. When viewed under a microscope, the injured tendon has significant tendon degeneration and disorganization. In other words, the tendon is dying. These microscopic findings are termed tendinosis. Tendinosis most often is found 2-6 cm from the insertion of the tendon onto the heel because this area tends to have less blood flow compared to the rest of the tendon. A poor blood supply means a poor capacity to heal.
Causes of injury vary with the individual. Nonuniform stresses across the tendon lead to degeneration, but the stresses are due to poor biomechanics of the foot, excessive or sudden increase in workouts (intensity, frequency, or duration), decreased recovery time between hard workouts, change of running surfaces, muscle imbalance, ankle instability, misalignment, or flat feet. These are the most common factors we have experienced in our office.
Treatment for Achilles tendinosis is very specific to the patient. In many cases, it requires a combination of treatments including a thorough assessment of strengths and weaknesses in the body. Soft tissue (muscles, tendons, ligaments) is inevitably involved, so soft tissue management systems such as Active Release Techniques (ART®) and Sound Assisted Soft Tissue Mobilization (SASTM / a.k.a. purple tools) are used to restore blood flow and reorganize the damaged tissue. Specific rehab exercises are often added to improve the integrity of the tendon as well.
Whether your Trojan War is walking to work, running a 10K, or training for a triathlon, keeping the Achilles tendon from being a limiting factor is a must. Let us know if we can help you with your battle.
Alfredson H & Cook J. “A treatment algorithm for managing Achilles tendinopathy: new treatment options.” Br J Sports Med. 41:211-216, 2007.