Achilles/Heel Pain - Help Appreciated

TripleB

Hall of Fame
I am currently having pain in my Achilles tendon area (back of heel and up a little) on my left leg. I played about 3 hours of doubles last night, had a slight limp because of the pain after playing, and then this morning I could barely walk because it hurt so bad.

It is always my left heel/Achilles. I tried squatting down this morning on each leg and noticed that when I squat with my right leg my knee pretty much goes over the front of my foot. When I squat with my left leg the knee moves inward.

I am wanting to know what I can do to heal the pain and what stretches (or other things) I can do to keep the pain from coming back?

BTW: It is not plantar fasciitis…I've had that before and this isn't in the same place or at the same pain level.

Thanks for any and all help.

TripleB
 
Most likely diagnosis is achilles tendonitis, which generally calls for REST until it calms down. What you need to know is that this condition increases the risk of rupture, so you really need to stop playing for awhile.
 
Most likely diagnosis is achilles tendonitis, which generally calls for REST until it calms down. What you need to know is that this condition increases the risk of rupture, so you really need to stop playing for awhile.

Thanks...I guess that means rest from tennis and running? ARGHHHHHH!!!

Will stretches help it heal faster or keep it from happening again in the future?

TripleB
 
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I'm finally getting over 6 months worth of Achilles tendinitis in both legs. I bought a portable ultrasound and portable electrostimulation machine to help with the healing and pain. I also used heat quite a bit on the area. It was minor pain but still annoying. Definitely stretch it out real well before AND after playing.
 
Eccentric exercise. Google it, or search for it on this forum. It will work better on the achilles than anything else you will do. If you lay off too long your calf will get weak and your achilles will be worse. Speaking from experience.
 
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Eccentric exercise. Google it, or search for it on this forum. It will work better on the achilles than anything else you will do. If you lay off too long your calf will get weak and your achilles will be worse. Speaking form experience.


Calf raises are also great for strengthening and stretching this area of your body.
 
Thanks...I guess that means rest from tennis and running? ARGHHHHHH!!!

Will stretches help it heal faster or keep it from happening again in the future?

TripleB

As tough as it seems to have to rest, you don't want to have chronic inflammation result in an abnormal tendon riddled with disorganized scar tissue (tendinosis):

achillestendonitis.gif


Or worse, a ruptured achilles tendon:

achilles_tendon_rupture.jpg



The Sports Injury Clinic has a pretty good description of achilles tendonitis, it's causes, and its treatment:
http://www.sportsinjuryclinic.net/sport-injuries/ankle-achilles-shin-pain/achilles-tendonitis

Some quotes:

"Achilles tendonitis can be either acute, meaning occurring over a period of a few days, following an increase in training, or chronic which occurs over a longer period of time. In addition to being either chronic or acute, the condition can also be either at the attachment point to the heel or in the mid-portion of the tendon (typically around 4cm above the heel). Healing of the achilles tendon is often slow, due to its poor blood supply."

"Causes of Achilles Tendonitis

Achilles tendonitis is an overuse injury. Too much too soon is the basic cause of overuse injuries, however other factors can contribute to developing the condition.

Increase in activity (either distance, speed or hills).
Less recovery time between activities.
Change of footwear or training surface.
Weak calf muscles.
Decreased range of motion at the ankle joint, usually cause by tight calf muscles.
Running up hills - the achilles tendon has to stretch more than normal on every stride. This is fine for a while but will mean the tendon will fatigue sooner than normal.
Overpronation or feet which roll in when running can place an increased strain on the achilles tendon. As the foot rolls in (flattens) the lower leg also rotates inwards which places twisting stresses on the tendon."

"What can the athlete do to treat Achilles pain?

Rest and apply cold therapy.
Wear a heel pad to raise the heel and take some of the strain off the achilles tendon. This should only be a temporary measure while the achilles tendon is healing.
Make sure you have the right running shoes for your foot type and the sport.
See a sports injury professional who can advise on treatment and rehabilitation."


It is important not to start strengthening exercises too soon. Pain is a sign that active inflammation is present, so pain should be resolved before a strengthening exercise regimen should begin. (It may be appropriate to do gentle range of motion movements while some discomfort is present.)

As always, a proper diagnosis from seeing a sports medicine doctor and direction under the care of a therapist can give personalized care to direct you through a potentially long process to minimize a chance for complications or recurrence.


Here is one set of exercises, however:

xachille.jpg

http://www.summitmedicalgroup.com/library/sports_health/achilles_tendonitis_exercises/

[I don't know whether you hit the gym or not, but in the further down the road, the squat and deadlift are the classic exercises that work all the muscles of legs, core and muscles that connect the legs and core. May be something to consider to help prevent other common leg, abdominal and back injuries. Even just a little strengthening is beneficial to tennis players.]


More on over pronation - a possible contributing cause of achilles tendonitis [and also is a contributor to plantar fasciitis which you say you also have had.]:

Over pronation is very common in those with flat feet.

If you are an over pronator, your foot rolls abnormally when you walk/run, putting excess stress on your achilles tendon:

Pronation316x278.jpg


The good news is that over pronation can often be corrected with an orthotic. Many even can be largely corrected with a good supportive insole like the Superfeet Orange or Green.
 
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Thanks for all the input...it is greatly appreciated!!!

It seems most (if not all) of my pain (when walking or pressing on the area), is located on the back of the heel, all the way around...more so than up the achilles.

TripleB
 
Thanks for all the input...it is greatly appreciated!!!

It seems most (if not all) of my pain (when walking or pressing on the area), is located on the back of the heel, all the way around...more so than up the achilles.

TripleB


A buddy of mine has heel spurs. The only way you'll know is to see a doctor.
 
Thanks for all the input...it is greatly appreciated!!!

It seems most (if not all) of my pain (when walking or pressing on the area), is located on the back of the heel, all the way around...more so than up the achilles.

TripleB

plantarfasciitis-spur.jpg


But plantar fasciitis can felt further back, all around the heel area:

Plantar-Fasciitis.jpg


plantar_fasciitis_heel_pain.jpg
 
TB, if it's tendonitis or tendonosis some initial rest (week or so with cold therapy), slowingly starting a eccentric exercise program (just google it) and possibly a particular type of iceing would likely all be heplful.

I had chronic Achilles tendonitis the past yr and even had two PRP shots in the late Fall - I am now 95% normal. I continue to do my eccentric raises exercise on a slant board (edge of stairs works fine too) almost every day and I use a specific form of icing that for me seems to help.

The cold treatment that worked for me: I live in a cold area so I can just use cold tap water this time of year. Fill a bucket or small trash can that the lenght of your foot can fit into, fill it to mid calf level with around 50 degree water or so (add ice if necessary), I usually go 10 minutes in the morning and another 10-12 after I play, I do this every day. This IMO is MUCH more effective then an ice pack. My Achilles is doing well and I am going to stay with this "management" program.

Drak
 
Update early March:

I've really upped my tennis (dubs and singles) the past few weeks and so far no probs with my previous Achilles issues. Perhaps the PRP shots along with the rest and then iceing and eccentric program finally did the trick, I continues to do a regular eccentric raise exercise program on a slant board and ice in cold water (in a bucket) regularly.

DRAK

Triple B how are you doing?
 
I am currently having pain in my Achilles tendon area (back of heel and up a little) on my left leg. I played about 3 hours of doubles last night, had a slight limp because of the pain after playing, and then this morning I could barely walk because it hurt so bad.

It is always my left heel/Achilles. I tried squatting down this morning on each leg and noticed that when I squat with my right leg my knee pretty much goes over the front of my foot. When I squat with my left leg the knee moves inward.

I am wanting to know what I can do to heal the pain and what stretches (or other things) I can do to keep the pain from coming back?

BTW: It is not plantar fasciitis…I've had that before and this isn't in the same place or at the same pain level.

Thanks for any and all help.

TripleB

Damn....I just recovered from this injury and it was not funny :-|

I can only recommend rest. Do NOT stretch your Achilles when you have only pain, this will only aggravate it. If possible flex your foot in a position where you do not stretch the Achilles at all, useful when sitting down or when sleeping.Some people use ice or a heating pad. I used ice for 5-10 mins a seesion 4 times a day, I used a frozen pea bag and it conforms to the shape of your 'injured' area. You can try light massaging or friction therapy (goggle this) this may or may not work for you....it didn't work for me, but alot of people have reported a positive outcome when using this. If and when you massage the area gently...if the area of pain hurts more than before, then stop this form of treatment immediately. I tried eccentric exercise during the time I had pain and after a few days of this, I decided to stop, as the pain got worse and worse...some people said to 'power through' the pain...you decide ....however I am doing this exercise after I have recovered from this injury. Another thing that may help is buying silicone heel pads that lift your heel slightly..insert them in BOTH shoes and use them if you have to be on your feet all day....they help alot.

These are the things I did in order to get better....it took a friggin 6-8 weeks...now I am pain free......however I have now bought a pair of Superfeet Orange just in case. I wish you the best, take care.
 
I have a friend who several times would have won his NTRP level, except that every time when the season gets to the end this problem flares up for him and puts him out. It's really his Achilles heel.
 
I'd also like to hear from TripleB to see what the problem ended up being and what treatment resulted.

I'm starting the 3rd week since I broke mine (just below the Achilles insertion point). Doc put me in heel lifts for padding and to keep the forefoot more extended. I go for a followup on the 15th. (spring season in jeopardy)..
 
I played through my pain for about 6 months and used ultrasound and electrostimulation on it every night. It is pretty much gone now. Just had a 3 week break from tennis due to gout. Now that I'm only wearing 1 sock, one of my heels has some minor discomfort on court. I'll go back to double socking this week.
 
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