Achilles Tendinits
Achilles tendinitis is a commonly occurring foot condition that leads to pain along the back of the leg near the heel. The Achilles tendon is the largest tendon in the body, and it connects the calf muscles to the heel bone. This tendon is used for jumping and running.
There are two types of Achilles tendinitis: noninsertional and insertional types. With noninsertional Achilles tendinitis, the fibers in the middle portion of the tendon have started to break down and the tiny tears swell and thicken the tendon. This more commonly affects young, active individuals.
With insertional Achilles tendinitis, the lower portion of the heel where the tendon attaches to the heel bone is affected. This particular type can occur for any type of patient, active or inactive.
What are the symptoms of Achilles tendinitis?
Like most foot problems, the symptoms vary from person to person. These include:
- Pain along the tendon or the back of the heel that worsens with activity
- Pain and stiffness which is worse in the morning
- Severe pain the day after exercising
- Thickening of the tendon
- Swelling that is present all the time or worsens after activity
- Bone spurring
What causes Achilles tendinitis?
Achilles tendinitis is not the result of a specific injury; the problem results from repetitive stress on the tendon. Other factors that cause this syndrome include tight calf muscles and bone spurring.
How is Achilles tendinitis treated?
Nonsurgical treatment for Achilles tendinitis involves rest, ice therapy, NSAIDS, special exercises, physical therapy, and supportive shoes and orthotics. Surgical treatment may be necessary if conservative measures fail. Occasionally a gastrocnemius recession is performed, where the calf muscles are lengthened. Surgery typically involves debridement and repair of the affected tendon.
The aim of this procedure is to remove the damaged portion of the Achilles tendon. Occasionally a tendon transfer is required when a significant amount of damaged tendon is present. The unhealthy portion of the tendon is removed and reinforced with a graft to prevent the remaining tendon from rupturing with activity.
Adult Acquired Flatfoot Deformity (AAFD)
There are many different conditions that can lead to adult acquired flatfoot deformity. This syndrome results in a fallen arch with the foot pointed outward. For this condition, most people require orthotics and braces. For those who have no relief with these measures, surgery may be an option. Your orthopedic specialist will plan a treatment regimen for you based on what is causing your AAFD.
What are the symptoms of AAFD?
The symptoms of AAFD vary from patient to patient. They include:
- Pain that is worse with activity
- Pain along the course of the posterior tibial tendon which is on the inside of the foot and ankle
- Pressure or discomfort on the outside of the ankle bone
- Bony bumps on the top and inside of the foot that make wearing shoes difficult
What causes AAFD?
The most common cause of AAFD is damage to the posterior tibial tendon. This structure is one of the most important tendons of the leg. It extends from a muscle in the calf and travels down the inside of the lower leg to attach to the bones on the inside of the foot. This tendon functions to hold up the arch and support the foot with walking. Other things that can cause AAFD include arthritis, injury, and diabetes collapse (Charcot foot).
Who develops AAFD?
Women and people over age 40 are most likely to develop AAFD. Other risk factors are hypertension, obesity, and diabetes.
How is AAFD treated?
When orthotics and braces do not work, surgical treatment for AAFD may be necessary. The type of surgery will depend on the degree of dysfunction. With stage 1 dysfunction (pain along the posterior tibial tendon with no loss of arch), surgery involves debridement of the tendon and repair of longitudinal tears.
The operation for stage 2 dysfunction (pain along the posterior tibial tendon with associated fallen arch deformity) is more complex and involves realignment of the heel bone, a tendon transfer to support the arch, and often a spring ligament repair. When the deformity is due to arthritis, surgery to fuse the bones of the hindfoot (triple arthrodesis) is often required.
Plantar Fasciitis
If you are experiencing pain on the bottom of your heel, you may have plantar fasciitis. This condition occurs when the strong band of tissue that supports the foot arch becomes inflamed and irritated. The plantar fascia is a thin, long ligament that lies just beneath the skin on the bottom of the foot. This ligament connects to the heel in the front aspect of the foot to support the arch.
What are the symptoms of plantar fasciitis?
Common symptoms of plantar fasciitis include:
- Pain after the first few steps when arising in the morning or after a long rest period
- Pain on the bottom of the foot or heel area
- More intense pain after (not during) activity or exercise
What causes plantar fasciitis?
The plantar fascia absorbs the high strains and stresses placed on the feet. Sometimes, however, there is too much pressure and damage or tears to the tissues of the foot occurs. When this happens, the body’s natural response to injury is inflammation resulting in heel pain and stiffness of the plantar fascia.
How is plantar fasciitis treated?
Nonsurgical treatment of plantar fasciitis involves rest, ice therapy, NSAIDS, exercise (calf stretch and plantar fascia stretch), cortisone injections, supportive shoes and orthotics, night splints, and physical therapy. Your orthopedic specialist will recommend what is best for you. If all these measures fail, occasionally shockwave therapy is an option. Surgery is rarely