How to Deal with Heel Pain - IFC Physiotherapy

Achilles Tendinopathy is the most common form of heel pain. But what is it exactly? How can it be treated and more importantly how can it be prevented?

Symptoms include pain:
•   at the beginning and end of exercising
•   after a long period of sitting or sleeping
•   If severe, can continue for the duration of exercising and interfere with daily life.

It is common in athletes who have an increase in training load, and is most often due to overuse. Tendon’s respond poorly to overuse. Also, they have only one third the oxygen supply of muscle, therefore any damage will take much longer to heal.

Achilles Tendon: connects your calf muscles into your heel. Its function is to push off in walking and running and to absorb and transmit the force from your calf muscles to your heel. It is the largest and thickest tendon in your body.

The two main subtypes of tendinopathies are tendinosis and tendinitis:

  • Tendinitis is inflammation in the tendon fibers. It’s an acute inflammation that can present with swelling, pain, warmth and redness. If this is treated early and appropriate treatment is given it can be resolved quite quickly. If not, chronic tendinitis can develop into tendinosis.
  • Tendinosis: is an accumulation overtime of micro-tears, which aren't given a chance to heal. There isn't necessarily inflammation with tendinosis, it is more so the inability of the tendon to heal that creates pain. Tendinosis tends to be more chronic, if ignored it can take up to a year to heal.

    Risk factors (1)
    Risk factors can be divided into internal (those inside the body) and extrinsic (those outside the body)

Intrinsic:
•   stiff ankles
•   weak calf muscles
•   flat feet/ increased ankle pronation
•   malalignment of the legs (for example knee/hip rotation)
•   Risk increases with age (particularly over the age of 40)
•   Male
•   Diabetes
•   Obesity

Extrinsic:
•   A rapid increase in training load (meaning either intensity or distance)
•   Training on hard, slippery or uneven surfaces like sand,
•   Too much uphill or downhill running
•   Inappropriate footwear

Treatment (2):
•   Decreasing training load to offload the tendon! Don’t worry its not forever, in order for the tendon to heal properly it needs to be loaded          somewhat so the most effective form of treatment is a progressive return to activity advised by your physio.
•   Stretching: in particular to the two muscles in your calf, your gastrocs and soleus.
•   Eccentric Exercises; eccentric means applying a stretch to a muscle while strengthening it. Most common example of this is dropping your        heel down over a step before raising up onto your toes. (3)
•   Orthoses; most effective in people who have had a pre existing foot malalignment. (4)
•   Taping: Kinesio Taping can offload the tendon and help for returning to activity (4)
•   Manual Therapy: either to the surrounding muscles which are pulling on the tendon or deep transverse friction to the tendon itself.
•   Dry Needling: Direct needling to the tendon has been found to reduce pain and promote healing. (5)

However as with a lot of conditions, prevention is key! (1)
•   Train smart! Gradually increase your mileage and your speed.
•   Ensure rest and recovery! As you are increasing your training, make sure to compliment that with extra rest and recovery methods.
•   Appropriate footwear; choose runners that are supportive and ideal for your type of arch.
•   Adequate warm up and cool down.
•   Strengthening and stretching programme of your legs in order to prevent excess pressure on the Achilles

Rehab and treatment varies for each person so if you have any queries over your achilles tendon or how to prevent tendinopathies, drop in to see us at IFC.

 

1.     Journal of Science and Medicine in Sport (2016) 205–211 Preventive interventions for tendinopathy: A systematic review Janne A. Peters a,b, Johannes Zwerver a, Ronald L. Diercks a, Marije T. Elferink-Gemser b, Inge van den Akker-Scheeka,
2.     Journal of Orthopaedic & Sports Physical Therapy, 2010 .Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association
3.     The role of eccentric exercise in sport injuries rehabilitation Antonio FrizzieroSabina TrainitoFrancesco OlivaNicolò Nicoli AldiniStefano Masiero Nicola Maffulli
4.     Sports Medicine January 2015, Volume 45, Issue 1, pp 95–110 Effectiveness of Orthotic Devices in the Treatment of Achilles Tendinopathy: A Systematic Review
5.     Tendon needling for treatment of tendinopathy: a systematic review Krey D, Borchers J, McCamey K The Physician and Sports medicine 2015 Feb;43(1):80-86