If you feel like you’ve just been kicked in the bottom of your heel, but turn around to see nobody there, you may be experiencing an issue with your Achilles tendon or plantar fascia. Ever since the coronavirus pandemic hit in 2020, there has been a rise in heel and Achilles injuries. There are many factors contributing to the rise in these foot injuries:
— Lack of exercise from being confined at home
— Lack of proper conditioning before any form of physical activity
— Wearing little to no footwear, which provides no support to your feet. Yes, this even goes for being barefoot at home. People would be shocked at the mileage one can walk while being at home.
The above issues can result in what’s been coined by myself as “pandemic foot” in an article with The New York Times, a term created due to the increase number of foot and ankle pain during and post-pandemic.
To prevent foot pain and injury, especially in the season of baseball, football and marathons, here is some important information about the Achilles tendon and the heel.
[READ: Why Foot Care Is Critical for Seniors.]
What Is the Achilles Tendon?
Your Achilles tendon runs vertically between your heel bone and calf muscles. Though the Achilles is the largest and strongest tendon in the human body, the blood supply to the area can decrease by 30% after age 30, and continues to lower with age. This decrease in blood flow only makes the tendon more vulnerable to injury. Chronic trauma or inflammation of the area can result in weakening of the tendon.
This means less elasticity, less strength in the tendon and an increased likelihood of an injury and tearing.
In addition to aging and decreasing elasticity, other causes of Achilles injuries include wearing improper shoes (especially for physical activity), tension on the area due to the person’s weight or exercise regime, lack of stretching or warming up before physical activity, sudden increase in force applied to the area’s weakest location (running to first base, pivoting after planting the foot on the ground, etc.) and suddenly returning to a sport after a period of inactivity.
It must be noted that the Achilles and plantar fascia can also be affected in the presence of many systemic arthritis disorders, such as rheumatoid arthritis and psoriasis. Many of these patients develop pain in both Achilles or plantar fascia insertions into the heel bone. These arthritic conditions often will also present with chronic lower back pain that extends for long periods of time.
If you feel any pain or discomfort in the Achilles area after activity, it’s important to call your doctor as soon as possible so the condition doesn’t worsen. One of the worst mistakes a patient can make is treating this problem themselves. Dr. Google should not be the first referral. Information not received in the right context can be dangerous and lead to worsening pain in the Achilles.
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Diagnosing Heel Pain
Heel pain is one of the most common foot issues that can affect people of all ages. Though common, heel injuries are also one of the most misdiagnosed musculoskeletal conditions. And injuries to the heel can be lifestyle-threatening, inhibiting someone’s ability to exercise, walk or even stand. The cause of heel pain can be primarily broken down into one of two conditions:
— An issue with the Achilles tendon
A study published by our Non-Surgical Foot & Ankle Center at the Hospital for Special Surgery indicated that there was a fair number of patients who were diagnosed with “plantar fasciitis,” when in fact they had a far more serious deep surface tear in the heel. In the absence of direct trauma or injury to the heel, plantar fasciitis is more prevalent in the right heel as most people are right-handed. Hand dominance has an effect on where the Achilles or plantar fascia is more likely to occur.
A patient will usually feel great pain when stepping out of bed in the morning. After 10 to 15 minutes, the pain typically subsides. The same pain will occur after sitting for a significant period of time, such as getting up after dinner or sitting while watching a film.
In addition, another condition called a plantar fibroma, which is a benign growth found within the fascia, was also found. These two conditions are often overlooked and can be as painful and debilitating as inflammation of the plantar fascia, which is responsible for shock absorption and protects not only the foot and ankle, but also reduces the stress that goes to the knee, hip and back. A plantar fibroma can produce pain at a very sudden rate, often when a person wears an ill-fitting shoe that puts pressure on the fibroma. The pain will usually last throughout the day, starting with the first step.
These conditions are treated differently, which is why the correct diagnosis is essential. If someone is feeling pain in their heel for at least two weeks, it’s time to see a doctor.
Achilles tendon
Usually to diagnose an Achilles problem, after examining, your physician may order an MRI (magnetic resonance imaging) or a diagnostic ultrasound. An ultrasound allows the doctor to specifically pinpoint where the inflammation is in the Achilles. The procedure is done in real time, where the radiologist can see the tendon in motion. MRI can be used to visualize soft tissue, but it has the advantage of being able to identify tumors and infections within the bone as well as ruling out the possibility of a fracture.
Pain in the Achilles tendon or heel is usually the result of one of three conditions:
— Achilles tendonitis: when the tendon swells and becomes painful and usually worsens with activity
— Heel and Achilles spurs: also called calcaneal spurs, these are bony growths that develop on the heel bone and can cause pain or tenderness on the bottom of the heel
— Ruptured tendon: can cause a sudden sharp pain and a popping sound. Patients often describe the sensation of the pain coming from behind, as if hit by a stick or a baseball bat.
Plantar fasciitis
Plantar fasciitis is caused by inflammation of the plantar fascia, a thick band of connective tissue that runs from the heel bone to the toes to support the arch of the foot.
Plantar fasciitis usually comes from overuse of the heel or improper footwear, causing sharp pain, stiffness or discomfort to the area. People who have to stand or walk on hard surfaces for a long period of time also have an increased risk of developing plantar fasciitis. Like Achilles injuries, plantar fascia issues are usually diagnosed by ultrasound, which can detect heel tears better than an MRI.
There is what is known as a “fat pad” that covers the fascia, which when injured is extremely painful. Heel pad injuries take longer to heal because the blood supply to this area is also low.
[SEE: Best Running Shoes.]
Sports Injuries and Heel Pain
Injury of both areas to the foot are very common because they’re they’re close in proximity and therefore, are easy to injure simultaneously. An undiagnosed injury to the heel can lead to a problem in the Achilles due to lack of proper care and treatment. With sports season in full swing, it’s very easy to get caught up in the game or the marathon you want to run. But, if you want to keep yourself in good shape for the whole season, it’s so important to properly warm up and take care of your feet, especially the Achilles tendon and the plantar fascia.
Numerous athletes have suffered injuries to these areas, ending their seasons or careers. Within the last year, Aaron Rodgers, in his first game with the New York Jets, suffered an Achilles rupture — and tried to make a comeback less than three months after his surgery. Unfortunately, the injury ended his season since the Jets had been eliminated from Super Bowl playoff contention shortly after his return to practice. Superbowl-winning quarterback Drew Brees suffered a plantar fascia tear that affected his ability to run and throw with power.
Pickleball‘s popularity has also resulted in an increase of Achilles and plantar fascia injuries.
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Treatment
It’s important to start with conservative treatments if possible, such as:
— Heating and icing
— Topical or oral pain relievers and anti-inflammatories
— Custom made orthotics
— Wider shoes/elevated shoes: Patients find relief when they wear shoes with a wider toe box to provide space and bring down swelling. Shoes with an elevated 1-2-inch heel also bring relief to patients. It mechanically reduces tension at the insertion points of both the Achilles and the plantar fascia.
— EPAT (Extracorporeal Pulse Activation Technology) : a non-invasive shockwave therapy that consists of pulses applied to the affected area to help break up scar tissue and promote healing
— Therapeutic ultrasound: a treatment that uses high frequency sound waves to heat and stimulate tissue and increase blood supply, which can reduce pain and promote healing.
— PRP (Platelet-rich plasma) injections: a therapy that uses the patient’s own blood to treat an injury or other physical conditions. The patient’s blood is spun into a centrifuge to separate it into layers, concentrating platelets in the middle layer. The plasma is then injected into the area that needs treatment to increase the concentration of growth factors and other proteins, which can help promote healing.
— MalleoTrain: a special orthopedic sock designed to stabilize the foot and ankle.
— Walking boot: a boot the patient wears to completely immobilize the foot, ankle and rearfoot to prevent any motion in the Achilles and plantar fascia.
Failure to identify and recognize the problem in a timely fashion often leads to prolonged disability and increased pain. Physical therapy that involves direct application to the injured area in the form of therapeutic ultrasound and other swelling and inflammatory modalities are recommended.
If the Achilles and heel pain is due to abnormal biomechanics, such as issues with footwear, or the shape of your foot, then an orthotic prescribed by a qualified practitioner is the best remedy. It’s important for patients to have custom-made orthotics, with prescriptions designed specifically for their foot types and conditions by their foot and ankle specialist. The shape and mechanics of the foot, as well as the activities the patient participates in can dictate what type of orthotics should be made with specific materials to help protect their feet while maintaining their usual lifestyle.
In the absence of this biomechanical issue, an over-the-counter device should suffice. But in the absence of blunt trauma, most Achilles and heel issues have a biomechanical origin.
Plantar fasciitis and heel pain is best treated without surgery — though some patients think surgery is the best course of action. Unfortunately, more problems can arise with heel surgery. And that’s if it is successful on some level. Sadly, most surgical intervention on those areas have shown to cause more harm in the post-op and recovery phase. Famously, Joe DiMaggio (who our DiMaggio Heel Pain Center is named after) had surgery for a heel spur, which is a bone growth on the heel bone, usually caused by added activity on the foot’s ligaments. Sadly, the surgery not only worsened his condition, but it shortened his record-breaking career as a New York Yankee.
Surgery is required only when the Achilles suffers a complete tear. In that case, it can take up to six months for the injury to heal with proper care if doctor’s orders are properly followed. However, some studies have shown that non-surgical options can be effective depending on the location and the extent of the damage to the tendon.
Bottom Line
Though Achilles and heel pain injuries like plantar fasciitis can be somewhat common, they don’t have to be lifestyle or career-ending. Through simple treatment and preventative measures, these injuries can be overcome with proper foot care and supervision from your doctor.
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Achilles Tendon and Heel Pain: Causes and Treatment originally appeared on usnews.com
Correction 11/08/24: A previous version of this story did not include all the treatment options.
