Achilles Tendonitis

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Achilles Tendonitis

Question:

For the last year or so, I've been suffering from serious pain in my Achilles tendon anytime I run or walk at a fast pace. I've been to a podiatrist, whose only advice after x-rays and several appointments was to stay off my feet and wear a boot to bed. Isn't there anything more I can do, or am I doomed to sit on the sidelines at the ripe old age of 37?

Answer:

I agree with you—giving up all weight-bearing physical activity seems pretty harsh. And, I think it's premature. There should be other options for you.

The Achilles tendon attaches the lower portion of the calf muscle to the back of the heel. It can become inflamed (Achilles tendonitis) due to:

• Overuse or sudden increase in exercise intensity or duration

• Bad shoes with too little cushioning or poor support

• Poor technique during stretching or exercise

• Tightness of the Achilles tendon

• Structural abnormalities of the foot, such as a high arch

• Medical conditions, such as diabetes or inherited conditions associated with elevated cholesterol levels (such as familial hypercholesterolemia)

But pain in that area can also be due to causes other than Achilles tendonitis, such as:

• Bursitis (inflammation over the back of the heel due to the rubbing of the shoe over the heel)

• Heel fracture, which may have happened even if you can't recall the injury

• Abnormal foot structure—a bony prominence at the back of the heel, high arches, or walking on the outside of the foot can all contribute to pressure on the back of the heel.

• Calf injuries, such as a muscle tear

• Arthritic conditions, such as reactive arthritis or psoriatic arthritis

Although treatment depends on the cause, many of these conditions respond well to:

• Anti-inflammatory and analgesic medications, such as acetaminophen or ibuprofen

• Stretching exercises, especially if the Achilles tendon is tight

• Heel lifts, pads, or other shoe orthotics (inserts)

• Changing shoes to something with a soft back or even no back

• Ice, especially if there is warmth or swelling over the sore area

• Physical therapy, including electrical stimulation or ultrasound treatment

• Casting

• Corticosteroid injections

In certain situations, such as structural abnormalities of the foot, surgery may be necessary. I'd suggest following up with your podiatrist or getting a second opinion to establish a specific diagnosis and to explore all of your treatment options. While a period of rest may be recommended for certain conditions (such as a fracture), it seems unlikely that permanent "retirement" from weight-bearing exercise is your best option.

Last updated:	March 03, 2009