Dr. Howard Liss treats disorders that cause pain and disability by providing consultative services and soft tissue and joint injections when needed. When medically appropriate, he makes specific referrals for diagnostic testing (lab work, imaging, electrodiagnosis), physical and occupational therapy, interventional procedures (epidurals and facet joint injections), and surgery.
As the largest tendon in the body, the Achilles tendon connects the calf muscle to the heel bone. It is capable of absorbing heavy stress from activities such as running and jumping. Even so, the Achilles tendon is susceptible to overuse and sports injury, particularly during intense exercise training or when individuals push their bodies to do too much. In this case, the individual or athlete will experience Achilles tendonitis, which is pain and inflammation along the back of the leg that extends to the heel.
To better understand, Achilles tendonitis is classified into two categories: Noninsertional and insertional. More common in younger individuals, noninsertional Achilles tendonitis occurs when there are degenerative changes in the tiny fibers located in the middle of the tendon. In effect, these fibers tear, swell and thicken. In turn, insertional Achilles tendonitis is a condition where there is damage to tendon fibers in the lower region. This is where the tendon connects to the heel bone. In both cases, tendon fibers are prone to harden or calcify. Particularly in insertional Achilles tendonitis, bone spurs form just above the heel bone.
As mentioned, the Achilles tendon is prone to overload, and this remains the primary reason for tendonitis. While rigid activity and sudden increases in the amount of exercise can contribute to tendonitis, tight calf muscles or improper stretching can also play a role. Cold and stiff muscles add strain to the Achilles tendon. In addition, training on a soft surface can lead to Achilles tendonitis, as well as running uphill, poor footwear or problems with an individual’s gait cycle.
Symptoms of Achilles Tendonitis
- Pain or stiffness in the tendon in the morning
- Pain that worsens with activity
- Intense pain the day after training or exercise
- Thickening of the tendon
- Hard, bony growth or spur above the heel bone
- Swelling and inflammation that worsens throughout the day
Treatment and Rehabilitation for Achilles Tendonitis
A number of treatment therapies and rehabilitation exercises prove useful for reducing pain, building strength and improving mobility for those suffering with Achilles tendonitis.
With a multidisciplinary and functional approach, physiatrists are in a unique position to assess and coordinate treatment. Physiatrists value non-surgical methods that empower patients during recovery, counseling them on body mechanics, avoiding injury and obtaining long-term functioning.
For acute tendonitis, treatment will primarily focus on reducing pain and inflammation, at least for the first few days. Individuals may ice for 10 minutes every hour, and they will likely be asked to rest. In some cases, when individuals must be on their feet, a heel lift or heel pad may be inserted into both shoes. This is a way to shorten the calf muscle and take extra strain off of the tendon. In the same way, the tendon may be taped using a specific technique to reduce strain.
For some patients, Achilles tendonitis is a long-term, chronic condition. In this instance, the application of heat is used instead of ice, and gentle massaging helps soothe the tendon. Exercises such as the Hakan Alfredson’s heel drop method proves effective for many individuals, as it concentrates on strengthening the tendon. Eccentric exercises such as the heel drop combined with stretches such as the gastrocnemius stretch and soleus stretch not only build stamina in the tendon, they work to stretch the calf muscle. Doing so naturally reduces the amount of strain placed on the tendon.
The rehabilitation of Achilles tendonitis may also involve the use of anti-inflammatory medication, electrotherapy, ultrasound and sports massage. Throughout treatment, physiatrists carefully monitor progress, and they obtain pertinent diagnostic information pertaining to the patient’s condition based on their body’s response to treatment.
At the Howard Liss, M.D. Rehabilitation Institute in Englewood, patients can rely on Dr. Liss to put together the right treatment, therapy and rehabilitation plan to ensure the most optimal outcome. Dr. Liss works closely with other specialists required to rehabilitate patients suffering from chronic pain or serious injuries, and Dr. Liss will refer patients as needed to ensure appropriate treatment. With extensive education and exposure to a variety of conditions that affect the cervical and lumbar spine, bones, nerves, joints, ligaments, tendons, muscles, brain, and spinal cord, Dr. Liss is uniquely positioned to help patients manage their pain and maximize their functioning.
To schedule an appointment, contact the Howard Liss, M.D. Rehabilitation Institute today.