Hi guys!
This video is specifically about
insertional Achilles tendinopathy. So,
where you get the tendinopathy where the
Achilles tendon attaches into the heel.
I'll give you some tips about that and
why you can't treat it
the same as a midportion Achilles
tendinopathy.
So, for those of you who don't know me, my
name is Maryke.
I'm one of the physios from
treatmyachilles.com, where you can get
online
physiotherapy assessment as well as
treatment of your Achilles injuries.
Have a look at the description of this
video if you want the link to our website.
Brilliant! So, insertional Achilles
tendinopathy: what is it?
It's basically if you feel your heel
bone...
it's when you have the tendinopathy where
the tendon attaches onto the heel bone
there.
Now, it's significant to distinguish
between the two types, because the other
type is when you've got the midportion
where you can feel it
kind of in this bit of the tendon, or
sometimes a little bit higher up,
because the treatment for the two is
very different.
The insertional type is usually caused
by
too much compression, because in that
area where the Achilles tendon attaches
to the heel bone,
it's very easy for that tendon to
compress against that bone too much,
and so compression is a big part of the
disease process or the injury process
there. Now,
if you go and do heel raises over the
side of a step
like they always advocate - and we advocate
as well - for...
the midportion Achilles tendons, you're
gonna make your insertional tendinopathy
so much worse. Because, guess what happens
when your foot drops over the side of
that step? As it drops,
your foot goes into dorsiflexion and can
you imagine... So
that drops. Can you see how that's going
to compress that tendon
even more over the bone? So that's the
big first no-no:
You cannot do your exercises for
insertional Achilles tendinopathy at the
beginning stages
over the side of a step. Yes fine,
eventually we want to get there, but
that's quite
a long way off. So, usually starting with
things to floor level or even
identifying if I get my patients to do
it with shoes on,
that they don't get into any position
where it compresses that tendon,
that makes a big difference. And often
doing isometrics rather than where
there's movement
can be useful as well. One of the nicest
things you can do for your tendon,
especially
if it's acutely flared up and painful, is
to not walk around barefoot
and not to walk around in flat shoes.
If you can put your feet into a
comfortable shoe, so one that doesn't
press directly on that spot
but that has a bit of a heel, like
regular trainers. Most of them have about
a 12 degree heel.
Or you can place some heel inserts -
don't just put it in the one, put it in
another one as well, otherwise you'll be
wonky -
that can just lift you up. Even quite
severe heel inserts sometimes,
if it's a really flared up one, that can
make a massive difference because it
just takes the strain off the tissue
and allows it to calm down. And of course,
as you
recover, we want to bring the foot into a
position where it's happy to take the
load
in flat... on the floor.
But at the beginning stages it's really
useful to just
lift it up a bit that we can desensitize
the tissue and allow it
to recover. So that's basically it! So if
you've got an insertional Achilles
tendinopathy,
avoid calf stretches because it's the
same thing as doing a
heel raise over the side of the step.
Avoid heel raises over the side of the
step
at the beginning stages. Later on in your
rehab, that has to be added in.
And initially, for the first few weeks,
see if you can get yourself into shoes
with a bit of a heel.
If you prefer flat shoes, see if you can
get some
cheap old heel raises off the Internet
and just stick them in there
for a while to allow it to recover and
then you can take them out again.
So let me know if you've got any
questions. If you need more help with
an injury, you're welcome to consult one of
us via video call;
link to the website is in the
description of this video.
Take care!