When the Pain Won't Go Away

Peter Wishnie, D.P.M.
Owner of Family Foot & Ankle Specialists in Piscataway & Hillsborough, NJ

With the recent side-lining of Kobe Bryant due to an Achilles tendon rupture, tendon problems have been on the mind of many. Since a rupture is a high impact type injury that usually occurs with a specific traumatic event, not many people are likely to suffer from this horrible condition. What is much more common, especially in runners and athletes, is Achilles Tendonitis.

Achilles Tendonitis is simply put, an inflammation of the Achilles tendon due to irritation and/or overuse. To understand how to treat Achilles tendonitis, first we must understand how the Achilles works. Not only is it the main plantorflexory muscle (Plantarflexion is the act of  going downward compared to the rest of the body; think of a ballerina coming up onto their tip toes, that’s plantarflexion) of the foot/ankle, it is also a major inverter of the foot (inversion is bringing your foot inward so it faces the other foot).

With this in mind, it becomes obvious that overuse of the these motions such as in running or jumping will lead to the muscle/tendon becoming “tired” especially in those who are wearing inadequate footgear. If the necessary rest is not given to a tendon to recover from a stress, then tendonitis develops.

Acute or short-term tendonitis is treated easily utilizing the RICE principle (Rest, Ice, Compression, and Elevation). Oftentimes changes in shoe gear and orthotics are necessary to modify and optimize the mechanics of the foot/ankle to make things function better. However, in this hectic fast paced world, symptoms of tendonitis are often under-addressed or completely ignored. When this happens, tendonitis becomes chronic and harder to treat. If you have ever had a “nagging” injury that will never go away, then you understand what I am talking about.

When Achilles Tendonitis becomes chronic, the tendon itself may become thickened. This is quite a common occurrence in the Achilles tendon. What the body is trying to do is lay down scar tissue and more tendon to strengthen itself. However, this “new” thickened tendon is often disorganized and weaker than a healthy tendon. As a result, the overall tendon is weaker than  it was originally and more prone to rupture/tearing, even though it appears to have become thicker. So in this case, bigger does not mean better.

Treating chronic Achilles tendonitis can be a bit tricky and often involves combinations of treatments and therapies and not just a solitary approach. The RICE principle I mentioned before is often combined with physical therapy as well as a combination of better shoes and orthotics or even ankle bracing. When a patient comes to see me who has chronic Achilles tendon, I will generally begin them with a one to two week period of immobilization either in a cast w/ crutches or in a walking cast boot. This provides the necessary rest to start the healing process.

Everyone, no matter what level of activity, will suffer from a foot/ankle malady at some point in our lives. The most important thing is how you address that injury when it happens. Please remember, we only have two feet, and we are all stuck with the feet we are born with. Please take care of your feet and they will last you a lifetime.