Achilles' Pain That Won't Quit

Question: I do a combination of walking and easy running for exercise. However, I have developed pain in the back of my heel that won't quit. My family doctor told me I have Achilles' tendonitis, but medication has not helped. What can I do?

Answer: Achilles' tendonitis is a common complaint. The calf muscle attaches from the back of your knee and joins the Achilles' tendon, which then attaches to the back of your heel. Everytime you take a step, your calf muscle contracts, lifting your entire body weight onto the next step.

Needless to say, the calf is a major workhorse as far as muscles go. This can easily stress your Achilles' tendon, causing inflammation.
When you run, the forces are even greater on the calf and tendon. Essentially, you are jumping forward with each step, applying a great deal of force to the tendon.

I developed this problem myself many years ago when running. Twenty-Five years ago I was advised to just quit running as the solution. This worked, even though I hated to give up running.

Several years ago, I began running again and yes--I again developed Achilles' tendonitis in my right heel.

This came as a result of two factors. First, I have foot pronation, where my feet roll inward. Many people call this flat feet, but I have plenty of arch. My foot simply rolls too far inward.

The second factor is that I have a short right leg. This has allowed my right calf muscles to become shorter in comparison to the left and tighten more easily.

Tighter calf muscles cause more strain on the Achilles' tendon, resulting in inflammation and pain.

Treatment for chronic heel pain may be as simple as regular, daily calf stretches. Remember, your calf is constantly working throughout the day and easily tightens. Stretching has been my most important tool in preventing the return of my Achilles' pain.

Good shoes are a must! Whether your foot pronates or not, you need good support for your foot and leg. Motion control running shoes are best. These help control the movement of your foot and reduce the excess torsion to the tendon.

I recommend going to one of the running stores in town where they will know how to fit your shoe correctly. I prefer Brooks as a brand, but New Balance is also very popular.

If stretching your calf and wearing good shoes does not take care of your problem, then the next step is to evaluate for a short leg or pelvic imbalance. If your hips are out of alignment, this can also put more stress onto one leg in comparison to the other.

We do a standing postural evaluation, followed by standing x-rays to evaluate your condition. In some cases, we use a heel lift in one shoe to correct for a short leg. Many people have one leg shorter than the other, up to 50% of the population. Even though this is common, it is still not normal.

A heel lift is easily placed inside your shoe. If fitted correctly, it is completely comfortable and you don't even know it is there. I wear a heel lift with orthotics in my running shoe comfortably.

It may be necessary to have a custom-made foot orthotic to control your pronation, if your shoe is not sufficient.

Lastly, our treatment includes deep massage to the calf muscles to break up muscle knots that can continue to pull on the tendon. We use ice, ultrasound and electrical muscle stimulation to help this process.

With the calf muscle loosened up, the tension comes off the tendon, eliminating the cause of inflammation.

Now it's up to you to keep them stretched out, and get back to your walking and running!

Copyright © 2008 - Konicki Schumacher Chiropractic. All rights reserved.
Dr. Tom Konicki is a board certified chiropractic orthopedist and has practiced for many years in South Dayton. You can reach him at www.kschiro.com or 937-439-5400. Mail your questions to Ask the Chiropractor, 2165 Miamisburg-Centerville Road, Dayton, Ohio 45459.