Achilles Tendon Pain Treatment Toronto |

The most important part of providing the best achilles tendon treatment in Toronto is to thoroughly access the root cause. At Yorkville Corrective Chiropractic, our approach is to correct the underlying problem with the body that leads to symptoms and complaints. Ultimately, symptoms are like your body’s “check engine light” and the elbow pain is usually the consequence of problems far beyond the ankle – the neck and nerves leaving that part of the spine MUST be assessed as a potential root problem. If you are looking for Achilles tendon treatment Toronto that looks to address the root cause and not just the symptoms then read on and learn by a comprehensive approach should be taken!

What Are The Symptoms Of Achilles Tendon Pain | Achilles Tendon Pain Treatment Toronto

Achilles tendonitis, which we now call Achilles tendinopathy is a chronic condition that sees degenerative and inflammatory changes to the tendon. These changes can occur in different portions of this tendon complex from repetitive over-use. Achilles tendinopathy is a common and painful condition that primarily affects runners but people of all activity levels as well. While it often with be less painful with rest, it usually requires manual therapy and exercise for treatment to reduce pain and correct the underlying causes that lead to the condition. Not just merely “Band-Aiding” the symptoms is why we think we provide some of the best Achilles tendon pain treatment in Toronto.

Below we will discuss the causes, signs and symptoms, risk factors and treatment methods that can help you avoid or eliminate this common condition.

Achilles Tendon Anatomy and How To Treat It

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  The achilles tendon is a very strong and thick tendon formed by the superficial medial and lateral gastrocnemius muscles and the deeper soleus muscle – together they are the triceps surae
• The muscles unite to form the tendon which inserts into the heel bone, also known as the calcaneus
• It is a solid piece of connective tissue formed primarily of strong bundles of collagen that run parallel to each other like many microscopic ropes. It is very excellent at accepting and distributing tensional forces but not compression
• The Achilles tendon rotates medially at its insertion, such that the soleus inserts more medially and the gastrocnemius more laterally
• when the triceps surae contracts, the plantar flex the ankle to point the toes, as in the case of a ballerina, or push-off from the ground during the running cycle
• The Achilles tendon is covered by a thin layer of synovial fluid-producing cells called that force a protective paratendon sheath
• Inserts into the bone histologically as follows: muscle, muscle-tendon junction, tendon, fibrocartilage, mineralized fibrocartilage, bone

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  A calcaneal bursa (a fluid-filled sac that lubricates and separates two structures in the body) sits at superior the 1/3 of the posterior calcaneus,

  • bone may be covered by fibrocartilage here
  • retrocalcaneal bursa is usually small with only 1-1.5 ml of fluid but can become inflamed and painful
• Achilles tendon is known to weaken with age

There are Three Main Achilles Tendinopathies

There are primarily three types of Achilles tendon injuries. We of course would assess for all three and you can at our Yorkville Corrective Chiropractic office can receive Achilles tendon pain treatment for all three. They are differentiated based on the part of the tendon that is injured

1. Insertional Achilles Tendinopathy (IAT)
2. Non-insertional Achilles Tendinopathy (NIAT)
3. Achilles Paratenonitis

NIAT and IAT share similar characteristics regarding their origin, cause and treatment. IAT refers to tendinopathy and pain located at the insertion of the tendon at the heel bone. NIAT occurs 2-6 cm above the heel bone in the body of the tendon. Achilles paratendonitis is an inflammation of the covering sheath of the Achilles tendon above its insertion into the calcaneus.

Both IAT and NIAT are believed to be degenerative tendinopathies. As explained in my Conditions Manual, these tendinopathies result from inadequate remodelling and strength of the Achilles tendon and pain results mainly from cellular changes in the tendon (more blood vessels, more nerves, degeneration of the tendon, less strong collagen fibres) rather than the acute inflammation seen with a traumatic injury.

Please read more about tendinopathy here

Eccentric Exercises for Achilles Tendon Treatment Toronto : Insertional and Non-insertional Achilles Tendinopathy

Eccentric exercise rehabilitation has been shown to be effective in the management of these conditions, likely by stimulating an inflammatory reaction within the Achilles tendon. This helps to reverse some of the degenerative changes and interrupt the painful generation of the blood vessels and nerves into the tendon. The exercise should generate mild discomfort toward the end of sets.

• maximal plantar flexion of the heel places greater strain on the anterior Achilles tendon and is recommended in the literature to target these damaged fibres
• For IAT, it is suggested that avoiding end-range dorsiflexion is important
• Please see the rehab video above

 

Insertional Achilles Tendinopathy (IAT): Why Does Insertional Achilles Tendinopathy Happen?

Is believed to result from tensional stress shielding (learn more here that sees the back of the Achilles tendon exposed to great strain than the front, which results in weakening and eventual failure on the most anterior tendon fibres

Rarely occurs in isolation (about 5%) of cases and often with retrocalcaneal bursitis

Is commonly associated with a Haglund Deformity (aka – pump bump) on the back of the heel

• Is a bony projection/enlargement of the posterior calcaneus
• Often associated with poorly fitting shoes, high arched feet and walking on the outside of the heels
• Is often associated with inflammation and growth of the retrocalcaneal bursa, causing painful bursitis
• Is usually more (posterior-lateral) outside on the back of the heel
• Seen in 60% of patients with insertional Achilles tendinopathy
• Could be non-painful but will often present with redness, heat and swelling in the presence of bursitis

Who Gets Insertional Achilles Tendinopathy

• 4x more common than non-insertional Achilles tendinopathy – the annual incidence in runners may be as high as 7-9%
• Is found in a higher association with athletic populations (more in older athletes than young)
• most highly associated in runners but happens across all activities levels
• high arches – cavus foot
• inflexible people
• often with Haglund deformity
• Common to present with retrocalcaneal bursitis
• shoe-related factors including, “insufficient heel height, poor shock absorption, and wedging from uneven wear” may play a role in causing excess force loading onto the Achilles
• In runners, excessive training without proper adaptation, training on hard or sloping surfaces, may predispose an athlete to injury
• Other comorbidities including hypertension, diabetes, obesity, steroid use, use of estrogen and fluoroquinolone antibiotics have been associated with Achilles tendon disorders as well

Non-Insertional Achilles Tendinopathy

This type of Achilles tendonitis occurs between 2-6 cm above the calcaneus in the mid-portion of the Achilles tendon. It is known as a degenerative tendinopathy whereby inflammation does not appear to be the key determinant in the disease process. While inflammation seems to be part of the process that sees the tendon degenerate, it is not the primary underlying process.

For a more in-depth understanding of this and other tendinopathies, please read Tendonopathies in my Conditions Manual

In short, a non-optimal (too much or too little) amount of force is put through the achilles tendon, which results in a number of changes on the cellular level that leave the tendon weakened. As part of the body’s natural healing process, an increased number of cells, blood vessels and nerves enter into the tendon, with the latter two believed to be a major cause of pain. In an attempt to heal the damaged Achilles tendon, the cells lay down less strong connective tissue, in a disorganized and weaker fashion. Paradoxically, the attempted healing response actually leads to a series of small partial ruptures, which lengthen the Achilles tendon.

Biomechanical factors that may lead to non-insertional Achilles tendinopathy

• weaker ankle plantar flexors
• increased ankle dorsiflexion range of motion
• Reduced calf muscle endurance
• biomechanical studies showed increased femur internal rotation and reduce tibial internal rotation was seen in runners with Achilles tendinopathy
  • The authors deduced that this could have resulted from tibialis posterior muscle weakness causing an overload of the medial gastrocnemius and subsequent strain of the Achilles tendon

Achilles ParatendonitisTreatment Toronto

Results from an over-use inflammatory reaction affecting the protective sheath around the Achilles tendon. A connective tissue sheath surrounds the Achilles tendon above its insertion into the calcaneus (heel bone). This layer of cells is similar in its makeup and function to that of the synovial membrane of a joint capsule; it is highly vascularized and innervated (↑ blood flow and nerve supply respectively) and works to lubricate the tendon so it may slide past adjacent tissues without friction.

This injury can either result from direct trauma or from repetitive overuse as with insertional Achilles tendinopathy. It will often present with (these symptoms and signs)

• direct pain upon palpation on the back or sides of the tendon
• swelling, redness or heat
• a palpable bump along the Achilles tendon above its insertion onto the calcaneus

It is believed that untreated or unhealed paratendonitis may progress to a non-insertional Achilles tendinopathy

Other Treatment Factors

A study has demonstrated altered muscle activation patterns of the calf muscles (Soleus on for less time and lateral gastrocnemius activated for longer) in those with Achilles tendonitis.

• Subsequent use of orthotics was shown to normalize these activation patterns. It is likely, although not proven, that electroacupuncture would achieve the same through its ability to neuromodulate.

Heel lifts may be effective in the management of Achilles tendinopathy but should be decided on a case-by-case basis.

• Some studies have shown that strain on the Achilles tendon is decreased with their use by altering leg muscle activation patterns.

Shoe modifications might help to accelerate healing from, or prevent insertional Achilles tendinopathy, in some cases.

• The insertion of the Achilles tendon can become irritated or chronically inflamed by a forward-pitched upper portion of the heel counter.
• A simple, and cheap, alternative can be to make a minor cut in this area of the shoe to reduce abrasion of the heel.

It has been recommended that heavy motion-control running shoes might perpetuate these injuries. The stiffer the shoe, the less force the shoe will absorb and will transfer it during gait to the Achilles tendon.

Rehab Considerations For Achilles Tendinopathy 

Eccentric Exercises  – see above

Other Muscle Strengthening

Strengthen the gluteal / hip musculature to ensure normal knee  running mechanics, reduced tibial internal rotation (a risk factor) and reduce strain on the medial gastroc complex

Strengthen the tibialis posterior to reduce strain on the medial gastroc

Strengthen the flexor digitorum longus muscle: this muscle works with the soleus during the gait cycle to reduce strain on the Achilles tendon.

Stretching

• stretching the calve muscles is an important addition to anything strengthening program
• stretches should be aimed at lengthening the calve muscles with straight and bent knee stretches
• mild tension for 35+ seconds every couple of hours – a slant board can be useful here as well

For Runners

Gait changes are recommended for patients moving forward

• Shorten stride length
• Use a pro-heel strike gait pattern
• Deliberately push-off of the toes during push-off
• Landing on the mid-or-forefoot (strike patterns), will reduce stress and strain on the achilles tendon.

Pain control modalities (acupuncture, adjusting, soft tissue therapy, taping) and additional manual treatments are important to reduce pain and correct dysfunctional movement patterns that lead to these conditions.

References

Michaud, Thomas C. Human locomotion: the conservative management of gait-related disorders. Newton Biomechanics, 2011.

Solan, Matthew, and Mark Davies. “Management of insertional tendinopathy of the Achilles tendon.” Foot and Ankle Clinics of North America 12, no. 4 (2007): 597-615.

Irwin, Todd A. “Current concepts review: insertional achilles tendinopathy.” Foot & ankle international 31.10 (2010): 933-939.