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Achilles tendonitis

Another Achilles injury!

Another Achilles injury!



Inflammation of the Achilles tendon is arguably the most common injury of the lower extremity.  The largest tendon in the body is a vital component during walking and running.  If the Achilles tendon is unprepared for stressful activity, then damage can occur, leading to inflammation.  If not properly treated, it can lead to long-term degeneration of the tendon (tendonosis, which is another subject entirely).

It always comes down to anatomy!

The Achilles tendon is made up of two muscles, the gastrocnemius and soleus.  The gastrocnemius is the most prominent muscle that you can visibly see and it begins above the knee, crosses the knee joint as it becomes a tendon.  In addition, it crosses the ankle joint as a tendon. The soleus is the muscle that is less visible, but only crosses the ankle joint as the Achilles tendon.  Both of these muscles function based on their location in the body, i.e., both of them can plantarflex the ankle, but the gastrocnemius can also bend the knee, making its ankle joint motion less effective.  The soleus can function irregardless o the knee’s position.  During ambulatory activity, the muscles (and to a lesser extent the tendon) are both lengthened when the leg swings forward during walking or knee lift during running.  The lengthening continues during foot contact and then begins to contract as the body moves over the planted foot, with the greatest activity during toe-off.

Could be dangerous if you are not ready...

Could be dangerous if you are not ready..

Like any overuse injury, there are intrinsic and extrinsic factors causing Achilles tendonitis.  The biggest extrinsic factor (and arguably the most important of them all) would be activity that exceeds the strength of Achilles tendon.  Examples include a sudden change of activity from low-intensity to high-intensity, i.e., walking to sprinting, introduction of hills to a walking or running program and returning to exercise after an insufficient or excessive long period of rest.  In all these cases, the Achilles tendon was not sufficiently prepared for this change of  activity, causing the tendon to become damaged.

Intrinsically, the foot posture is a large factor in Achilles tendonitis.  A low-arched foot lengthens the tendon naturally by its position. This gives the Achilles tendon little opportunity to absorb foot impact during ambulatory activities, causing increased stress on the tendon.  A high-arched foot has a natural reduction of flexibility in the Achilles tendon, so the increased stress of foot impact can cause damage to the tendon.

Isometric exercise--force applied, but same length of muscle

Isometric exercise–force applied, but same length of muscle

Treatment of Achilles tendonitis involves multiple steps guided by the injured individual and the simple fact that is usually takes three to five days for a normal tendon to recover from injury.  First, the stress of the Achilles tendon must be reduced in order for the tendon to recover adequately.  Heel lifts are a classic example, along with shoes with a higher heel.  Orthotic therapy for foot posture can reduce Achilles tendon strain also.  Next a progressive rehabilitation program to improve the function of the Achilles tendon.  This program should be devised according to pain and activity level of the individual.  An example of a program would be a progression of:  isometrics (pressing ball of foot against the wall), toe raises (moving from double to single leg), short two-legged jumps, single leg hops, explosive hops, skipping and then running.  The intrinsic factors must be continued to addressed in order to prevent recurrence, i.e., orthotic therapy or strengthening exercises for the foot posture.  If it is not addressed, it could lead to tendonosis.

Please contact me if any questions!

Health and happiness!


June 13, 2014 Posted by | Uncategorized | , , , , , | Leave a comment

NFL and Achilles tendon injuries

As an outsider looking in, I have noticed an inordinate number of Achilles tendon injuries at NFL camps (nine the last time I looked) this year.  As many try to explain them away as not related to the lockout, I would contend it is precisely due to the lockout that these injuries are occurring.

The Achilles tendon is the longest and thickest tendon in your body.  It is made up of two muscles, the gastrocnemius (which is more easily seen and referred to some as the “calf muscle” with its two heads) and the soleus muscle (which is deeper in the body and makes up most of the tendon).  They join together to form the Achilles tendon and occupies the bottom quarter of the leg. It inserts at the back of the heel bone (calcaneus).  This anatomy makes the tendon a powerful force during accelerations, sudden stops and sprinting activity.

Jumping to Achilles tendon readiness

Massaging the tendon after intense activity


Even though the Achilles tendon is not a muscle, studies have shown that it has contractile properties, so it should be treated as such.  Sensible, progressive training principles should be done to help strengthen the Achilles tendon and give it adequate viscoelasticity.  Typical training methods, such as resistance exercises, plyometric training and sprint training all provide strength to the tendon, and recovery activities, such as stretching and massage therapy, provide pliability to the tendon (so it will be useful for the next training session).  These methods such be put into place for months before full game day activity is attempted.

Struggling to get into game shape with limited training time is certainly a dilemma.  If someone asked me (and no one will!) how I would solve this, I would tell them to do less volume daily, but increase the restorative activities.  This will do two things, allow the athletes to do more intense work on a more regular basis, because they are recovered fully and also give the athletes a fitness base with the restorative activities such as circuit training or stationary biking.  Then, like any fitness program, slowly increase the volume of intense work as the weeks progress.  As a podiatrist, I would add two measures in regards to the Achilles tendon:  add in some eccentric heel drops, made famous by Alfredson;  and of course, to wear some shoes with no heel lift, i.e., Altra,  during the day (not during exercise) to provide increased Achilles tendon activity.

Always back to shoegear!

Hopefully all the players get into game shape and are able to play the beloved sport of football! Please contact me if you have any questions.

Health and happiness!

August 10, 2011 Posted by | Foot and ankle injuries, Resistance training | , , , , , | Leave a comment