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Heal your Achilles Heel

Most cases of achilles pain that we see at our clinics have reached the tendinosis stage. In simple terms this stage is where the cells are degenerated and not repairing properly. This is different to Achilles tendinitis where inflammation is the primary process.

There are many factors to consider for effective healing of an Achilles tendinosis. The purpose of this article is to provide you with some useful pointers to promote recovery.

1. Tight muscles
The calf muscles are generally tight in people with Achilles conditions. Stretching exercises are often very useful, but at the same time, they can aggravate the condition if overstretched. Most commonly the inside of the calf is often tighter and therefore usually leads to pain on the inner side of the achilles tendon or on the insertion attachment on the inside of the heel.

To stretch this muscle effectively, you can turn the foot away from the body slightly to increase the stretch to the medial gastrocnemius. Bending the knee slightly will increase the stretch further down, nearer to the achilles tendon.

2. Weak muscles
Muscles not only function to move a body part, but also absorb energy like a spring. The achilles tendon is an important shock absorber with almost any weight bearing activity we do, like walking, running, jumping etc. When your calf muscles are weak, they will not be able to function efficiently to absorb the shock or move your body in tandem with the demand of your activity. Hence the impact will be instead taken up by the tendon itself leading to dysfunction.

To train the shock absorption function of your calf muscles, stand on the edge of a step (heel off the step) and perform heel raises (go on to your tiptoes) and then the slowly drop the heel down (heel dip) (about 3 seconds) just before you feel the stretch in your calf muscles, push the heel up again. You will feel the obvious weakness of your affected leg especially if you do it only on one leg. You will notice that the heel can’t go up as high and you need significantly more effort compared to your other leg.

3. Foot Arches
A high arched foot has a smaller surface area in contact with the ground. It is also stiffer into pronation which is what your foot should normally do as it bears weight. The combination of poor shock absorption from impaired pronation and a smaller area will increases the amount of force that goes through the high arch foot. A higher arch tends to have the heel rolled outwards and a lower arch tends to have the heel rolled inwards. This means that the achilles tendon will not be lifting the heel up normally. Instead it will be lifting up the heel plus tilting the heel sideways, either inwards or outwards.

4. Foot biomechanics
When your foot and ankle joint are too stiff or too lax, they either have poor shock absorption or your muscles have to exert more force to stabilise. The biomechanics has a lot to do with the foot arches too (see above).

Customising foot orthotics or inserting of heel wedges may help to correct such dysfunction in biomechanics. The physiotherapist may also perform mobilisation techniques to help facilitate movement in the foot and ankle joints.

5. Training intensity
As mentioned above, tendinosis is a degenerative stage where breakdown of cells is faster than your body’s ability to repair, i.e. overuse. Be mindful of how much you are exerting yourself. Some variables that you can take note of are, speed, distance, terrain etc. For example increasing running speed, walking further or running up a slope can aggravate the injury.
Try increasing the intensity by 10% each week, and always listen to your body.

No pain no gain is definitely not the mantra for healing an Achilles tendinosis.

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