(upbeat music)
- For Achilles tendonitis,
surgery to remove the bone spur
is rarely a necessary treatment option.
More often, non-surgical treatment is the best choice
to alleviate your symptoms.
- In general, you wanna treat Achilles tendonitis
very aggressively in terms of rest,
ice,
compression and elevation.
Those are the things that we wanna really start with,
because those really help reduce the inflammation.
Achilles tendonitis is not something
that we can just put a Cortisone injection in
and get a quick result
and you're back on the field.
You need to stretch,
you need to work with a physical therapist.
In general, I find that you need
to work with a physical therapist
because doing it on your own can be painful
and it could limit
your ability to get better.
You wanna have somebody who's trained,
who's going to help you along with this process.
I find physical therapy to be a really great tool
for recovering from Achilles tendonitis.
Wearing heel lifts, using your orthotic device,
which is a long term for an arch support
that we make for you
to correct any abnormal ways
that you're walking that might be
making it worse.
In general, we start with a heel lift,
because that's something we can dispense right away.
The heel lift is just a thin piece of ...
We just use a felt piece
that you can put underneath the heel,
both your shoes,
so you don't fall ...
You know, so you're not lopsided when you walk.
In general,
this just lifts up the Achilles tendon,
lifts up the heel,
and takes pressure off of it.
When you walk, you don't have to hit the ground so far.
This is an orthotic device, or an arch support.
You take the liner out of your sneaker
and you put it right into your shoe.
In general, what it does is,
help to take pressure through the whole time
that your foot is on the ground.
It gives a lot of pressure relief.
It hold up the heel.
It holds up the arch.
So it minimizes pressure
with each step that you take.
So the Achilles tendon can actually heal
and pressure can be relieved for that tendon.
Achilles tendonitis rehab
commonly takes about three to six months,
to fully rehab an Achilles tendon.
That's to where you want,
you're back to doing everything that you want to do again.
There will be limitations in what you do
for the first at least six weeks,
because rest is a really important component
of Achilles tendonitis resolution.
You really wanna make sure
that that tendon heals properly
so you don't have any injuries long-term.
- [Jessica] The main goals of physical therapy
for Achilles tendonitis
are to develop a home exercise program
and a treatment plan to specify
the needs of the patient,
whether it's a biomechanical issue,
a flexibility issue, or a strength issue.
Determine the source and the cause of the tendonitis.
The causes of Achilles tendonitis
are typically an overuse-type injury.
People who exercise
and increase the intensity and duration
at a quick pace,
rather than a gradual increase in exercise,
develop more of the tendonitis.
It can also be a biomechanical issue,
whether the placement
and the shape of one's foot
puts the angle at fault.
One of the most common treatment techniques
that we tell people to do at home for Achilles tendonitis
is to stretch their gastro-soleus,
or their calf muscle.
Your calf muscle is made up
of two separate muscles,
one the gastrocnemius.
The second is the soleus.
The gastrocnemius crosses the knee joint,
so when we stretch that muscle,
your leg is gonna be straight.
The opposite is true for the soleus.
We're gonna do that one with a bent knee, okay?
I tell most people to do this stretch
at home against their wall.
We're gonna get you to stand up.
- Okay.
- I threw a towel down here on the floor.
The reason I have the towel on the floor is,
you're gonna step on it and away
so that the Achilles and the arch is supported,
the natural arch on the bottom of the foot is supported.
With your left foot,
I'm gonna have you step on the towel
so that the front corner of your foot,
kind of like a postage stamp, is on the towel.
Your right foot is gonna come forward,
and your hands are gonna be placed up against the wall.
What you wanna make sure,
when you look down,
you want your toes to be lined up,
directly pointed towards the wall
and not rotated out at all, okay?
As you gently push against the wall,
you're gonna feel a stretch
right up the back of your leg
and down into your Achilles tendon.
I tell most people to hold this stretch 20 seconds,
and you're gonna repeat it about five times.
The second stretch is for the soleus muscle.
This muscle does not cross the knee joint.
So we're gonna take the knee out of the picture.
Typically, I will now move the towel up,
and your leg is gonna become the front leg.
You're gonna step on the towel
the exact same position.
Now your front leg
is gonna lunge towards the wall.
You wanna maintain contact of your heel
with the ground,
and your knee is bent slightly towards the wall
until you feel a pull in the back of your leg.
Again, you wanna hold this 20 seconds
and repeat five times.
Pronation of the foot is typically
the inward and downward rotation
of the ankle and foot complex when you take a step.
This is a natural response to any gait pattern.
However, some people overpronate,
which puts stress on the ankle.
There's also the opposite, underpronation,
where they're not pronating enough.
When we assess the structure of the foot,
we're looking at an arch,
whether a person has what's considered a normal arch,
or too flat or too high of an arch.
In this case, the patient has a normal arch.
We look for the orientation of the Achilles tendon,
whether it's in a vertical position.
Additionally, somebody with too low of an arch,
the foot will bulge to the inward step
and you'll get a C deformity of the Achilles tendon.
The reverse of that,
too high of an arch structure,
the Achilles will kind of bulge
to the lateral aspect.
This is gonna change the alignment
of the calcaneus bone,
which the Achilles attaches to.
The progression of therapy
starts off at the impairment level.
We look at flexibility and strength as the source.
We will educate the patient on self stretches
and strengthening.
If the patient is athletic or sport-specific,
we will advance them to those type of agility exercises.
We will have them doing box jumps
or ladder drills
to not only strengthen the tendon
but also get them back to their prior level
of function and recreational activities.
Footwear and Achilles tendonitis
are very closely linked.
A properly-fitted shoe can
decrease the likelihood
of developing Achilles tendonitis.
It can also assist in the recovery process
and the prevention of reocurrence of the injury.
Improper shoe wear can increase the likelihood
and reoccurrence of a tendonitis.
Achilles tendonitis is a preventable injury.
Taking a few simple precautions
can help you avoid this condition.
You can begin by checking the alignment of your foot.
While there are many high-tech,
expensive ways to evaluate your arch
and whether you're flat-footed,
first try this simple approach.
I call it the "wet foot test."
Step in some water with your bare feet
and then step on dry pavement or cement.
Your wet foot leaves a print
of the weight-bearing surface of your foot.
A normal pattern shows your heel,
the outer edge of your foot,
and the forefoot, or the front of your foot.
The inside of your arch
should not leave a print.
If you have a high, rigid arch,
then the pattern shows your heel,
less of the outer edge of your foot,
and a smaller portion of the front of your foot.
If you are flatfooted or overpronate,
you'll show a whole footprint.
Knowing the alignment of your foot
can help you determine if you are more at risk
for developing Achilles tendonitis.
If you do suffer from Achilles tendonitis,
try using arch supports.
It can significantly reduce the stress
placed on your Achilles tendon.
If you're unsure of what type to choose,
ask your podiatrist or orthopedic surgeon,
and they can guide you.
Even some specialty running shoe stores
can assist you in finding the correct combination
of proper fitting shoes and orthotics
to suit your gait pattern
and your foot alignment.
Finally, always remember to stretch.
You have to do a proper warmup
prior to beginning any physical activity or workout,
especially if you have Achilles tendonitis.
This is an essential, often-overlooked, part
of any workout.
Stretch and loosen the tissues.
This will allow you to better absorb force
in whatever activity you choose to participate in.
And that's the art of medicine.
(upbeat music)