How to Diagnosis Achilles Tendinitis
Achilles tendinitis is primarily diagnosed by an examination. This includes evaluating, especially including palpating or feeling the patient's foot and watching the patient stand and walk or run, otherwise known as a gait analysis. I also palpate the other foot for comparison. The history, exam, physical activity description, foot pain symptoms help me identify the cause and make the diagnosis. I may use a MRI and X-Rays of both feet, and a special X-Ray called a scanogram, X-Ray of both legs to measure for an anatomical leg length difference; average difference in 98% of the population is 1/4".
(Scanogram of Legs)
What Causes Achilles Tendinitis?
The primary cause of achilles tendinitis is the reduction of the normal angle of inclination of the heel bone visible fron an X-ray of the foot from the side.
(Side View of Feet)
What is Achilles Tendinitis?
Achilles tendinitis is inflammation of the achilles tendon just above its anchor point in the heel bone (calcaneus). The calf musculature is primarily made up of the gastrocnemius and soleus muscles and are the upward extension of the achilles tendon. Symptoms include achilles pain, especially during the first few steps in the morning after getting out of bed, or after being in a seated position or after a period of rest. The pain usually subsides after a few minutes of walking and/or running. The achilles tendon tissue is also connected to the tissue under the foot, the plantar fascia.
How to Treat Achilles Tendinitis
The practice of Chiropractic involves maintenance of the structural and functional integrity of the human body. A doctor of Chiropractic may manipulate any and all of the body's joints, muscles, and connective tissues. During the course of treatment many physical agents, modalities, techniques, and therapies are available to me as your chiropractor to assist in my treatment.
1. Chiropractic adjustments, especially to the lower back, stretching of the foot, calf and lower leg, including the Hamstring Back Stretch, along with the use of the "Strassburg Sock" during sleep.
2. Special Foot Pain Taping technique. This immediately shortens and supports the origin and insertion points of the plantar fascia, reducing the physical load on the ligament by improving the heel angle, limiting foot pronation and also reducing the pulling on the achilles tendon. Additionally, Kinesiology Tape Achilles can reduce the pulling sensation on the tendon.
3. Another very effective palliative (pain relieving) therapy modality treatment is ultrasound, especially if the foot can be submerged in water (hydrosonic therapy). This special use of ultrasound significantly magnifies the micro-massage and anti-inflammatory benefits of the sound waves. As always for pain, crushed ice for 20 minutes 2 to 4 times a day or 5 to 10 minutes Dixie cup massages 2 to 4 times a day is indicated.
4. Other therapy modalities that can provide pain relief are electro-stimulation/relaxation and cold laser.
5. Natural anti-inflammatory supplements:
6. Purchase the best shoes for you by using the techniques in The Right Running Shoes. Always use stability or motion control running shoes (NO CUSHIONED or MINIMALIST SHOES), even for walking activities and reduce the intensity and/or frequency of ballistic activities and time standing on uncarpeted floors. NO barefoot walking or Barefoot Running!
7. Dr. Paul's Custom Orthotics with a special correction for the short leg and heel spur accommodation, if needed, is the best long-term approach to treat and prevent achilles tendinitis, as these orthotics put the feet in a normal alignment under the legs, correcting both the abnormal heel angle and excessive foot pronation and the true leg-length difference!
Dr. Paul R. Copeskey, DC, CCFC
The abnormal collapsing of the arch is usually caused from ballistic activities, i.e. exercising, running and/or playing sports involving running and jumping more than the foot and lower leg can tolerate. It is also a direct result of the normal process of aging, in that we log 3 to 5000 miles per year on our feet and the arches gradually get lower or flatter as the ligaments under and on the inside of the foot get looser with just the walking activity. Walking is usually one and a half times our body weight with each step taken, where running can be 3 to 6 times our weight. Achilles tendinitis is frequently referred to as a "repetitive stress or over use injury." The impact is made worse by running or hiking on uneven terrain, uphill, downhill, or hard surfaces. As the bottom of the foot flattens down or pronates, the added pulling on the plantar fascia eventually pulls on the achilles tendon from below. Another cause of achilles tendinitis is an increased amount of landing on the balls of the feet, as would occur in a sprinting situation or just purposeful attempts to land on the balls of your feet, i.e. Pose Chi running methods, running barefoot, or in minimalist shoes. Improper footwear, inadequate shoe lacing techniques, including worn out shoes can also contribute to achilles tendinitis. If the pain is on one side worse than the other there is an excellent chance one leg is truly longer than the other.
(Leg Length Difference)