Do You Have Achilles Tendinitis?

Do you have pain at the back of your foot, just above the heel?  It could be Achilles Tendinitis.  Achilles Tendon

The Achilles tendon is the largest tendon in the human body. It is located at the back of the ankle joint and attaches the calf muscles to the heel bone. This tendon is used to walk, run, jump and push up on the toes. Achilles tendinitis is the inflammation of the tendon and is most often caused by overuse, or is a result of a strain injury.

SOME CAUSES

According to orthopedic foot and ankle surgeon, Dr. Mark Yakavonis, aging and sports activities that involve a lot of calf muscle usage, like basketball and tennis, have a higher incidence of injury to the Achilles tendon. Achilles tendinitis is also associated with a sudden increase of intensity or frequency of an exercise.

“People with Achilles tendinitis usually feel a dull ache or pain during activity and they may feel tenderness above the heel bone, particularly in the morning,” Dr. Yakavonis said. Stiffness that improves as the tendon warms up and mild swelling or a bump are other possible symptoms. However, sudden pain, swelling above the heel, difficulty walking or moving the foot up or down may indicate a rupture of the tendon. “Whenever there’s pain in that tendon area, it’s a good idea to have an orthopedic foot and ankle specialist take a look at it to determine if it is due to tendinitis or a more serious condition such as a partial tendon tear, heel bursitis or a rupture,” he said.

TREATMENT

When treated properly, Achilles tendinitis is usually resolved quickly. When left untreated, it may lead to a more serious condition or tear.

Some or all of the following may be used to treat the condition depending on its severity:

  • Rest

  • Nonsteroidal anti-inflammatory medication

  • Orthotics or shoe inserts that help support the muscle and relieve stress on the tendon

  • Bracing to restrict motion

  • Physical therapy that includes stretching, massage, ultrasound and strengthening exercises

  • A home exercise program

SURGICAL TREATMENT

Surgical treatments vary depending on the type of Achilles tendinitis a patient has and the severity of it. Some minimally invasive surgical treatments, addressing the calf muscle or heel bone, are new and exciting. If friction between the tendon and its covering sheath causes the sheath to become thick and fibrous and conservative treatments are not effective, surgery may be an option. A surgeon can remove the fibrous tissue and repair any tears. In some cases, where there is severe damage, the Achilles is reconstructed using an adjacent tendon. A temporary cast may be worn during recovery and a rehabilitation program is usually recommended.

PREVENTION

Dr. Yakavonis recommends the following tips to prevent Achilles tendinitis:

  • Choose a running shoe that provides cushion to the heel.

  • Walk and stretch to warm up gradually before exercising.

  • Stretch and strengthen the muscles in the calf.

  • Increase running distance and speed gradually.

  • Avoid unaccustomed strenuous sprinting and hill running.

  • Cool down gradually after exercise.

What is Dry Needling?

IS DRY NEEDLING THE NEW WEAPON AGAINST CHRONIC PAIN? 

The ancient art of acupuncture and the modern treatment called dry needling have one thing in common. They both use tiny filament needles to promote healing. shoulder pain

Acupuncture aims to restore a person’s well-being and balance by placing the needles into specific points in the body to open up the body’s Chi, or energy flow.

With dry needling, on the other hand, the target is pain caused by severe muscle spasm, inflammation or injury.  It is a medicine-based treatment that uses needles to stimulate blood flow and promote natural healing to an area of the body that is affected by pain.  The needling therapy leads to a series of intricate chemical reactions in the brain, such as the release of a neurotransmitter called adenosine, which blocks pain. In addition, the chemical response increases natural opiates that leads to an overall decrease in inflammation.

According to Tanya Kalyuzhny, DPT, director of physical therapy at the Greenwich, CT office of ONS, dry needling can be an effective treatment to disrupt neuro-musculoskeletal pain patterns, release muscular limitations and provide relief from other painful orthopedic and spine conditions.

“Dry needling is a useful technique to remedy a range of painful conditions from stubborn muscle tightness to back pain, temporomandibular joint dysfunction (TMJ) and tendinitis,” Kalyuzhny said. Dry needling has been shown to be one of the most effective procedures to release trigger points. For this reason, therapists also use dry needling with patients suffering from fibromyalgia, a condition that can be difficult to treat manually because the points of pain are deep into the muscle.

During the treatment, a physical therapist who is trained and licensed to perform the procedure will insert a needle directly into a point of spasm in the muscle band, known as a trigger point, or around the region of pain or injury. The therapist will gently maneuver the needle until the targeted muscle twitches in response.  The needle is then wound inside the tissue by turning it in a clockwise or counter-clockwise direction. Turning the tissue allows the collagen fibers to wrap around the needle and release toxins from within the muscle. The needle remains inserted into the trigger point for 10 to 30 minutes, during which time patients may experience momentary muscle cramping or a dull ache at the site. The needle is then unwound back to its starting position, which leaves the wrapped fibers in a relaxed state.

“The release of toxins can result in soreness and bruising for a day or two following the treatment,” said Kalyuzhny. Some people experience pain relief shortly after the procedure. However, additional treatments may be required depending on the nature of the chronic pain and other factors.  It can take as many as three treatments to start noticing a change.

While the treatment is relatively new to the general public, dry needling in use with high performance athletes who need to get back into the game as soon as possible.  “Professional athletes often rely on dry needling to loosen tight muscles and relieve pain caused by tendinitis and other sports injuries,” Kalyuzhny said

In most cases, dry needling is part of a larger therapeutic program that includes retraining and strengthening exercises to restore normal function and control of the affected musculature.  ONS has a number of physical therapists who are trained and licensed in dry needling. You can schedule a consultation to find out if dry needling is a pain management option for you.

What’s Causing Your Heel Pain?

The foot has more than 30 different joints. If you consider the tons of stress your feet endure from walking and standing day in and day out, it’s no wonder that heel pain is the most common problem affecting the foot and ankle.

“Feet are anatomically designed to handle the pressure … to a point,” said orthopedic foot and ankle specialist, Mark Yakavonis, MD, “Repeated pounding on a hard surface while running, participating in another sport, or wearing ill-fitting shoes that inflame the foot’s tissues can cause pain on the bottom of your heel or behind it. Arthritis, wear and tear, or a build-up of uric acid in the small bones of the feet, known as gout, can also cause heel pain.

In most cases, heel pain can be relieved without surgery. Rest, stretching exercises, and possibly anti-inflammatory medication can usually do the trick. If left untreated, Dr. Yakavonis warned, a sore heel will only worsen and can develop into chronic and more problematic conditions.

For that reason, it’s important to consult with a an orthopedic foot and ankle specialist to determine the underlying cause of pain in your heel if it lasts more than a few days. A medical consultation is particularly imperative if the pain  intensifies when you put weight on the foot, if there are signs of infection or injury, such as swelling, discoloration or fever, or if your heel is warm to the touch.Foot picture

SOME COMMON CAUSES 

According to Dr. Yakavonis, pain under your heel can occur if you’ve bruised the heel pad by stepping on a hard object such as a rock, or from repetitive pounding on hard surfaces during sports. This pain usually goes away over time with rest.

If the pain beneath your heel is mild at first but then flares up when you take your first steps in the morning, you may have plantar fasciitis, This condition  is caused from inflammation of the tissue band (fascia) that connects the heel bone to the base of the toes. Plantar fasciitis is the most common condition causing heel pain. If plantar fasciitis is left untreated, a painful heel spur (calcium deposit) can develop where the fascia attaches to the heel bone.

PAchilles Tendonain from behind the heel could indicate inflammation of the bursae and the Achilles tendon at the point where the tendon goes into the heel bone. Achilles tendinitis and associated pain from retrocalaneal bursitis can build slowly over time, causing the skin to thicken, become red and/or swell. In some cases, a bump that feels warm to the touch can develop at the back of the heel. If pain increases with the start of an activity after a period of rest or if it is too painful to wear shoes, your physician may order an X-ray to determine if a bone spur has developed.

Injuries to the nerves in the foot can also produce heel pain. Neuropathy, or nerve damage, and Tarsal Tunnel Syndrome, in which the large nerve in the back of the foot becomes pinched and inflamed, are the two most common nerve-related conditions.

If you experience pain that makes it difficult to walk or enjoy your everyday activities, schedule an appointment at ONS with one of our foot and ankle orthopedic specialists, Michael Clain, MD or Mark Yakavonis, MD, by calling 203-863-1145 or request an appointment here.

07/10/2019

What do you do when you are diagnosed with an old (chronic) Achilles tendon rupture?

Mark Yakavonis, MD, MMS, is an orthopedic surgeon who specializes in foot and ankle surgery. Dr. Yakavonis has expertise in treating a variety of foot pain and deformity related conditions including Achilles tendonitis, ankle instability, cartilage injuries, bunions and hammer toes.  His practice will also focus on youth athlete sports injuries and the types of injuries seen in field athletes, gymnasts and ballet dancers.

Achilles tendon ruptures will often not be discovered for months after the injury. In the months between injury and showing up at the doctor’s office, the torn tendon develops scar tissue which decreased the quality and elasticity of the tissue. Because of this, directly repairing the torn tendon, as is done in an acute injury, becomes is less than ideal. In this situation, we will supplement the tendon repair with a tendon transfer. Essentially, we borrow a tendon that bends the big toe (there is another tendon that compensates when it is borrowed), reroute it, and reattach it to the heel bone. This does two very important things:

1. It supplements the strength of the torn Achilles, allowing a quicker and better recovery.

2. It provides improved blood supply to the Achilles repair, providing healing factors to the area of diseased tendon.

In summary, ruptures of the Achilles Foot_AnklePictendon are increasingly common in our aging yet increasingly active population. In cases where an Achilles rupture is missed or the rupture cannot be repaired directly under normal tension, adding the flexor hallicus longus tendon transfer allows for significantly improved results with a shorter recovery.

If you suffer from foot and ankle pain and would like to attend a free seminar, Dr. Yakavonis of ONS is an orthopedic surgeon specializing in foot and ankle surgery, and Greenwich Hospital will present Solutions for Foot & Ankle Pain: Beyond Foot Massage . He will present treatments and surgical techniques for bunions and other foot deformities. Learn more and register online here.

07/10/2019

Do You Experience Foot or Ankle Pain?

Mark, Yakavonis, MD, MMS, will be speaking at the Noble in Greenwich Hospital December 9th at

6:30pm to address Solutions for Foot & Ankle Pain: Beyond Foot Massage. Here is a summary of what he will present:

A painful foot or ankle condition can limit a patient’s function and quality of life with every step. Conditions from the toes to the Achilles tendon will be discussed with emphasis on surgical and nonsurgical options, including old standards and the most cutting edge new technologies. Topics covered will include foot and toe deformities such as bunions, hammertoes, flat feet, and high arches, with special attention to when and how these conditions should be treated or when they should be left alone. Plantar fasciitis and Achilles tendinitis will be discussed in detail with emphasis on the natural progression of the disease, what we know works and what is experimental. Arthritic conditions of the foot, ranging from the big toe to the ankle will be included.

A team approach is an important aspect of foot and ankle care. ONS physical therapist Alicia Hirscht, DPT, SCS, CSCS will discuss and answer questions about the role of physical therapy to improve foot and ankle pain and dysfunction.

ONS Senior Clinical Specialist Alicia Hirsch
ONS Senior Clinical Specialist Alicia Hirsch, DPT, SCS, CSCS

Dr. Yakavonis will introduce an orthotic maker he typically works with and will discuss when and how orthotics are used, from inexpensive over-the-counter inserts to custom molded prostheses. Other options to be discussed will include stem cell technology and image-guided injections.

Dr. Yakavonis will open up a question and answer session following the seminar. This event is free registration requested, call (203) 863-4277 or (888) 305-9253, or register online at:  https://www.greenhosp.org/CREG/ClassDetails.aspx?sid=1&ClassID=7253

Foot Ankle Pain Brochure

07/10/2019