The Achilles tendon is a structure that connects the calf muscle to the heel bone on the back of your foot. Pain in the Achilles tendon usually occurs on the back surface of the heel and sometimes it extends up the back of the lower leg. The Achilles tendon does not have a direct blood supply. This makes it very difficult to heal a plantar fascia injury.
The Achilles tendon is very important in maintaining the structural stability of the foot and in propulsion of the body during walking. It is important in aligning the rearfoot so the foot can propel the body forward during walking. Injury or rupture to this structure makes walking extremely difficult and can limit mobility or your ability to exercise. Sometimes the heel bone develops a bone spur from the traction that can cause pain when compressed.
Causes of Injury
Congenital or developmental tightness of the calf muscles, overuse, overweight, single or multiple trauma and, or inherited flatfoot condition can damage the Achilles tendon and cause posterior heel spur syndrome.
Having diabetes causes glycosylation of all tendon structures and can add to the chances of rupture. Rupture of the plantar fascia in a diabetic person can cause further weakening of the foot and potentially further collapse of the foot.
Immobilization and Protection:
This is the single most important treatment. You must protect the injury to give it a chance to heal and to lessen the chance of total rupture of the tendon. A cam walker boot is used in more severe cases for the short term protection and functional foot orthotic devices are used for less severe injury and for long term treatment, to prevent harmful pronation of the foot during walking. Aperture padding can be used to protect the posterior spur or prominence.
Steroid Injections and Non-Steroidal Medications:
Cortisone shots reduce pain temporarily. They do not heal the injury, and can cause rupture of the tendon. Cortisone shots are harmful and contra-indicated for this condition. Non-Steroidal Anti-Inflammatory Medications do not relieve inflammation in tendons and give a false sense of security which may prevent you from properly protecting the injury.
Can be mildly helpful to relieve symptoms temporarily but is not capable of stimulating healing of an injured tendon lying deep in the foot. Stretching of this structure by the therapist may be counterproductive and prolong the injury healing time.
Cutting Edge Laser MLS Therapy:
MLS Laser Therapy is a focused therapeutic treatment given 3 times per week for 4 weeks. The applied wavelengths of electromagnetic energy, stimulate blood flow to the tendon, stimulate healing of the cells within the plantar fascia, and has an analgesic effect. We charge $10.00 per treatment which is not covered by medical insurance.
Shock Wave Therapy:
Shockwave is administered one time weekly for 5-6 weeks. The shockwave does not hurt, does not require anesthesia, and will not injure the tissue. Shockwave does stimulate an acute healing cascade in the tissues. We charge $125.00 per treatment and it is not covered by insurance. It is frequently used in conjunction with Cutting Edge Laser Therapy as they work synergistically.
Topaz Surgical Repair of the Tendon and Removal of Bone Spurs:
This procedure is performed in the operating room. An incision is needed for this procedure only if bone spurs need to be removed. Multiple burn holes are created in the Achilles tendon with the Topaz wand. The burn holes allow ingrowth of blood vessels into the tendon. Using a needle inserted into your heel bone, bone marrow containing stem cells is extracted and injected directly into the burn holes. It is believed the stem cells further encourage tendon healing and improve the outcome of the operation. The procedure temporarily weakens the tendon but eventually stimulates it to heal. Post operatively a cam walker boot must be worn for six weeks to give the plantar fascia time to heal. All surgery carries risks and possible complications that will be discussed during surgical planning.
Conservative measures are always preferable. Immobilization and protection with cam walker boot followed by orthotics after the acute phase for severe injury, or just orthotics in a more mild injury is the first thing that must be done. The injury cannot heal unless it is protected from any further trauma. Stimulation of healing is safely and effectively performed with Cutting Edge Laser MLS Therapy.