Achilles Tendonitis or is it Bursitis? Does it Matter?

Did you know that there are more than 250,000 Achilles tendon injuries in the United States each year? Of these injuries, almost 25% require some kind of medical intervention to heal. A fully ruptured tendon requires surgery. Most other injuries can be treated conservatively and will resolve without surgery.

The most poorly understood Achilles tendon injury is actually not an injury of the tendon, but an inflammation of the bursa sac that separates the tendon insertion on the heel bone from the back of your ankle. The fluid in the bursa actually allows the tendon to move smoothly over the bone. When the bursa sac becomes irritated from frequent or abnormal movement, it becomes inflamed and bursitis can set in.

Achilles bursitis, also known as retrocalcaneal bursitis, is a common overuse injury in runners, hockey players, football player and many other athletes. Improper shoe gear and too much, too soon, too fast syndrome are usually the cause of this pain in the heel. It can also be seen in non-athletes who wear poor shoe gear or low cut shoes. Often it is seen in people with rigid, high arched feet.

Bursitis is a painful swelling that occurs in the back of the heel just deep to the Achilles tendon insertion on the heel bone. This inflammation makes it painful to squat, lunge or run uphill. Many shoes press on this area and make the pain worse. Even running on uneven or soft surfaces can increase the inflammation.

First line therapy for Achilles bursitis is rest, ice, heel lifts or heel cups and gentle stretching. Many patients require physical therapy and functional foot orthotics for complete relief of symptoms. Severe cases my even require a period of non-weight bearing casting or bracing prior to physical therapy in order to decrease the inflammation of the bursa. Chronic cases may even require more invasive therapy with extra corporeal shock wave therapy or injection of platelet rich plasma to jump start the healing process. Surgery is rarely needed unless bursitis is ignored for a significant period of time.

Long standing Achilles bursitis can cause significant difficulty in ankle movement and often a spur will form within the insertion of the tendon. Left untreated, this can eventually cause a rupture of the Achilles tendon at the insertion and lead to life long disability. If you are experiencing painful swelling in the back of your ankle, seek the help of your podiatrist early, so you can get back to running quickly and avoid any long term effects of this chronic inflammatory syndrome. 

So Run Happy! And Injury Free!

Achilles Tendon Rupture in The News!

It has been a rough early fall for Misty May-Treanor, Olympic Beach volleyball champion. She was in the preliminary rounds of "Dancing with the Stars" when she ruptured her Achilles tendon in practice. She had successful surgery on her tendon and hopes to be back to competition soon. Many people have asked "If such a terrible injury happened to such a conditioned athlete, how can I prevent it from happening to me?"

The Achilles tendon is the largest tendon in the human body. It is a large ropelike band of fibrous tissue in the back of the ankle that connects the powerful calf muscles to the heel bone (calcaneus). When the calf muscles contract, the Achilles tendon is tightened, pulling the heel. This allows you to point your foot and stand on tiptoe. It is vital to such activities as walking, running, and jumping. An Achilles tendon rupture is a complete tear through the tendon, which usually occurs about 2 inches above the heel bone.

The Achilles tendon can grow weak and thin with age and lack of use. Then it becomes prone to injury or rupture. Certain illnesses and medications can also increase the risk of rupture.

Rupture most commonly occurs in the middle-aged male athlete (the weekend warrior who is engaging in a pickup game of basketball, for example). Injury often occurs during recreational sports that require bursts of jumping, pivoting, and running. Most often these are racquet sports and basketball, but any forceful push off can cause a rupture. Most ruptures are obvious and the person experiences a sudden and severe pain may be felt at the back of the ankle or calf—often described as "being hit by a rock or shot." The sound of a loud pop or snap may be reported. Initial pain, swelling, and stiffness may be followed by bruising and weakness. The pain may decrease quickly and smaller tendons may retain the ability to point the toes. Without the Achilles tendon, though, this would be very difficult. Standing on tiptoe and pushing off when walking will be impossible. A complete tear is more common than a partial tear.

Tendon strain or tendon inflammation (tendonitis) can occur from tendon injury or overuse and can lead to a rupture. Most likely, although not reported, Misty May-Treanor had a minor chronic tendonitis from her volleyball competitions and then aggravated it with the strain of dancing. "Dancing with the Stars" training has been reported to be significant and quite taxing even to the athletes that are competing!

How can I prevent this happening to me? Treat any tendon symptoms before they lead to rupture! Call your doctor if you have any signs of minor tendon problems including pain with activity, swelling and problems with standing on your toes. Tendon strain or tendon inflammation (tendonitis) can occur from tendon injury or overuse and can lead to a rupture. Prevention centers on appropriate daily Achilles stretching and pre-activity warm-up. Maintain a continuous level of activity in your sport or work up gradually to full participation if you have been out of the sport for a period of time. Good overall muscle conditioning helps maintain a healthy tendon.

What should I do if I think my Achilles tendon is injured? Any acute injury causing pain, swelling, and difficulty with weight-bearing activities such as standing and walking may indicate you have a tear in your Achilles tendon. Seek prompt medical attention from your doctor or emergency room. Do not delay! Early treatment results in better outcome. The majority of people return to normal activity levels with either surgical or nonsurgical treatment. Most studies indicate a better outcome with surgery. Athletes can expect a faster return to activity with a lower incidence that the injury will happen again. Return to running or athletics is traditionally about 4-6 months. With motivation and rigorous physical therapy, elite athletes may return to athletics as early as 3 months after injury.

Remember that your Achilles tendon is needed for almost all activities! Treat it right and see your podiatrist if you have any symptoms of Achilles tendonitis to avoid an Achilles tendon rupture like Misty May-Treanor!

Stretching 411

The jury is still out when it comes to stretching in the running community. I have been running for almost 30 years with multiple coaches on numerous competitive levels, all of them told us to stretch daily to get faster and avoid injury. Yet many incredibly competitive runners never stretch and never seem to get injured. Is there any proof that this common recommendation is actually valid? What do the studies say about stretching? Does it really prevent injury? Will it make me faster? Again, the experts really don’t agree on much!  In most arguments between stretchers and non-stretchers, it inevitably comes down to "stretching helps prevent injuries" and "stretching is a leading cause of injuries in runners".

1. Warm up prior to stretching. Walk or slowly jog at least 10-15 minutes prior to stretching.
2. Slowly add stretching to your workout slowly. Gently stretch a little more each day. Your muscles can actually stretch almost 1.5 times their length, but if you try to achieve this all at once you will hurt yourself!
3. Relax. Tension makes it almost impossible to stretch effectively
4. Breathe. That may sound easy but try to breathe from you diaphragm or stomach
5. Make it a routine, try to stretch every day, even if you don’t run. Follow the same order of stretches every time for consistency
6. Listen to your body. Some days, less is more!

1. Don’t bounce!! Bouncing risks pulling or tearing the muscle you’re trying to stretch and relax. Muscles must be stretched gradually.
2. Don’t hold your breathe
3. Don’t stretch if it hurts
4. Don’t forcibly stretch an injured muscle, gentle and less is more
5. Don’t hurry through your routine
6. Don’t listen to your friends opinions about the best technique for stretching  Try them all and decide what works for you

Bottom line: Most experts agree that stretching reduces muscle soreness after running and results in better athletic performance. Gentle stretching after a race or intense workout can also promote healing and lactic acid removal from the muscles. Stretching is most effective when performed several times each week; a minimum of one stretching session per week is sufficient to maintain flexibility. Most coaches and runners believe in stretching before and after every workout. The experts never agree on much, but the majority seems to feel that stretching is beneficial to runners if done properly. So follow the precautions outlines and always warm up prior to stretching. Your body will thank you and who knows, you may even get a little faster!

Run Happy! And warm up and stretch before!

Achilles Tendon Woes

This week a very good runner from Wichita Falls came in with an Achilles tendon problem. He gave a horrible story of a primary care physician who injected his Achilles bursae TWICE with cortisone. He was looking for better answers and was willing to drive almost 2 hours south to find them.