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October 24, 2008

ACHILLES TENDONITIS Rehab with mobility, stretching

On the Mend

Have you been limping for weeks? Is the back of your ankle sore? Does your calf and heel feel tight? If you're dreading being on your feet for another minute you may have Achilles tendonitis.

Achilles tendonitis affects a broad spectrum of people. It is common in runners and walkers, hikers and people participating in sports. However, it is not limited to athletes. In fact, athletes make up less than 20 percent of the cases of Achilles tendonitis.

Men and women are affected equally and usually without a known cause. For those of us who are carrying around a few extra pounds — breathe a sigh of relief — Achilles tendonitis is not associated with being overweight. In fact, there is no one specific body type that is more prone to acquiring the disease. Clinically I cannot suggest that losing weight won't help in the dissipation of pain, but it is not mandatory to resolve the problem.

Direct physical trauma rarely results in a case of tendonitis in the ankle. Repetitive trauma, commonly referred to as repetitive strain or overuse strain, is entirely different and accounts for an overwhelming percentage of all patients seen in clinic. Repetitious activity that tugs at the fibers running throughout the tendon will cause an inflammatory response. Swelling begets swelling, and what started as a small case of inflammation can develop into a large-scale inflammatory cascade.

Achilles tendonitis has several origins. Most cases are directly linked to stiffness of the ankle joint. Stiffness is a result of many factors. Improper shoe wear, working on your feet for extended hours and generalized poor flexibility make you a candidate for acquiring a painful heel.

There are numerous, effective self-management measures you can take before seeking a structured treatment program. First, try icing your heel. Icing minimizes local swelling and reduces the pain of the inflammatory process. It also limits blood flow to the area, an important mechanism in cases that have lingered for months.

Stretch. Stretching three to four times per day for at least 30 seconds each time will help to keep your Achilles tendon loose. A tight tendon means perpetuation of the problem, so work hard restoring your tendon's normal length.

Sneakers are lined with a soft, cushy heel that helps to absorb shock and distribute force equally through the foot and ankle. Also, sneakers do not have a high heel. A raised heel places the foot in plantarflexion (toes pointed downwards). This perpetuates the disorder by shortening the tendon.

While many of us have jobs where sneakers are not a part of the dress code, there are several ways we can spend less time in our work shoes and more time in our sneakers.

First, don't put your work shoes on until you're officially on the clock. Whether you drive or take the train, spending more time in "sneaks" will help your problem. As soon as the whistle blows at the end of the day, fight the urge to dash out of the office — take the extra minute to put your sneakers back on before you go home.

Unfortunately, many people receive antiquated advice and are placed in a walking boot or plaster cast for several weeks. The old theory was that if you prevented the tendon from moving during walking, the inflammation would subside. This is a short-sighted and largely inadequate way of solving the problem. When the boot is removed, the Achilles tendon is shorter and more brittle than it was before its application, so be wary if a health care practitioner suggests immobilization for any period of time.

Physical therapists recognize that above all, Achilles tendonitis is a disorder of immobility and stiffness. During your rehab program, a physical therapist will work to restore the normal mechanics of your foot and ankle — returning your tendons to their pre-injury status.

Patients who work with a physical therapist who uses aggressive mobilization and stretching should expect a 50 percent reduction in pain inside of two weeks, given, of course, that they are compliant with their portion of the rehab program. With a focused, dedicated rehab effort, mild to moderate cases can be resolved inside of a month and severe cases inside of six weeks. If your ankle is getting worse, come in for treatment and we'll put the spring back in your step

¢¢¢

Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He works in the outpatient division of Beverly Hospital and writes "On the Mend" weekly.¬ Questions may be submitted to On the Mend, c/o Salem News, 32 Dunham Road, Beverly, MA 01915 or e-mail features@eagletribune.com.

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