Is this your Achilles heel?


Inflammation, pain and swelling to the Achilles associated with difficulty in walking, should point the athlete to possible Achilles tendonitis. Often caused by overuse, tight calf muscles or a high tight heel counter in the trainer shoe, which irritates the Achilles tendon.
Training should immediately be stopped and ice applied to the area plus the provision of a heel lift into both shoes (instability and postural compensation could become a further problem if the raise were positioned in just one shoe!). It is important to not walk barefoot too and fast assessment of the problem will lead to quicker treatment and limiting of the condition. Sometimes foot function is abnormal and prescribed orthoses may help prevent future episodes.

Warm up and down plus daily stretching routines even Pilates (which is good for core stability and maintaining strength and flexibility to prevent further injuries) should be encouraged.

Chronic rupture will take the athlete out of sport for a considerable length of time. Surgical repair is performed but healing is slow as the tendon slip is quite avascular (not many blood vessels). Calf muscle weakness and pain may also still persist for up to a year post-operatively.

To conclude – the message is stay flexible, stretch, stretch and strengthen daily, assess footwear and seek a biomechanical assessment with a podiatrist especially if you have other lower limb associated troubles eg knee pain.

SESAMOIDITIS (chondromalacia)

Sesamoiditis is a little used description of pain under the big toe joint.Here two sesamoids sit under the toe. Not ‘true’ bones their function is to increase the range of motion at this joint by providing a fulcrum for a tendon to run through which then inserts under the end of the big toe. Repeated stress and impact plus a form of degenerative arthritis can cause inflammation to these two ‘bones.’ Sport where multi-directional forces and forefoot balancing is employed eg tennis or ballet can cause this problem.

The first treatment is to off-load and deflect pressure from this area with padding, insoles or orthoses. In shoe pressure measurements and electronically sensitive plates can be used by your professional to record where the load is highest in the foot during the pushoff phase of walking. Such systems are available more and more and are proving especially useful in people with for example, diabetes, as the results and ensuing treatment with insoles/orthoses can prevent future problems.

In both of the above instances, it is important that diagnosis and treatment are started asap so that the athlete can come to terms with the problem and recovery times.

Kate Millns BSc (Hons) DPodM MChS

Podiatrist in Private Practice, Edgbaston, Birmingham – raising foot health awareness plus online foot health directory

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