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.
- 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. 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.
- 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.
- Physical Therapy
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.
- Heat vs Cold
Ice is used only to stop bleeding. Although everyone recommends Ice for almost anything that hurts. This is wrong thinking. Use heat to increase the circulation. Increasing circulation washes out toxins and promotes healing. Use wet heat daily and consistently to promote healing.
- Shock Wave Therapy
Pneumatic shock wave therapy will injure the tissue with pressure and start the healing process. Following the procedure that will take place in the office, Patient receives 4-5 weekly treatments until healing is achieved. Estimated time is 6 weeks.
- Cutting Edge Laser MLS Therapy
MLS Laser Therapy is a focused therapeutic treatment given 3 times per week for 4 weeks. The laser beam shows right through the skin and soft tissue and increases the circulation directly around the tendon and bone.
- Topaz Surgical Repair of the Tendon
This procedure is performed in the operating room. No incision is needed for this procedure. Through multiple puncture holes in the bottom of the heel, burn holes are created in the plantar fascia 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.
Combination therapy always works better. Each part contributes to healing in different ways.
- Immobilize and protect with orthotics in some cases cam walker boot.
- Stimulate healing with shockwave therapy.
- Increase circulation to the tendon with Cutting Edge Laser Therapy 3 times per week.