WHY IS ACHILLES TENDONITIS SO COMMON?

Although it is most associated with runners or running, Achilles tendonitis is common among participants and players across many sports and activities including dancing, tennis, racquetball, basketball, soccer, and many more. As part of this discussion, I’ll be reviewing and describing some of the factors that contribute to Achilles Tendonitis as well as some of the causes, preventative measures, diagnosis, and treatment options.

Achilles tendonitis occurs in nearly 8-10% of all athletes.

What are some of the causes of Achilles tendonitis?

Repetitive impact loading activities seen as overuse, jumping, and ballistic movements are responsible for many of the cases.

One of the major causes of Achilles tendonitis is poor foot mechanics or excessive pronation. Excessive pronation sets the body up for most of the painful lower extremity injuries.

In the excessively pronated foot, the subtalar joint collapses. This causes the tibia to rotate internally and thus the femoral segment follows. As this occurs, the pelvis also tilts anteriorly and puts the hamstrings under constant tension. The lower back develops an exaggerated lordosis and the upper back positions in an exaggerated kyphosis. The head and neck assume an anterior head carriage. As a result, the body is pre-loaded for a disaster to happen. The level at which the symptoms develop is usually at its weakest link.

In reference to the Achilles, as the foot pronates it abducts the leg as the leg is rotating internally and creates a wringing-out effect on the Achilles (similar to the wringing out of a washcloth). But in this case, instead of water, what is being wrung out is the blood supply to the Achilles structure. 

When this occurs, the Achilles tendons as well as the muscles involved in the myotendinous junction become irritated, undernourished, and develop crepitus, which then develops into painful tendonitis. Keep in mind that tendonitis is a precursor to a tear.

Additional contributing factors:

Overtraining, a sudden increase in the intensity of training, changes in surfaces, the addition of hills, improper shoe gear, and fluoroquinolone antibiotics have also been shown to be possible causes of Achilles tendonitis.

Clain and Baxter have classified Achilles tendonitis into two anatomical categories. They have described them as insertional Achilles tendonitis involving the enthesis and the non-insertional disorder, which involves an area of 2 to 6 cm. proximal to the calcaneus. In their experience, (and in mine) non-insertional Achilles tendonitis seems more common in the younger more active athletes, which may be due to the higher intensity and the inability to slow down the velocity of excess pronation compared to the older athletes, who are less intense, less active, and/or overweight. It has also been proven that after the third decade, the vascularity of the Achilles tendon is dramatically reduced.

In addition, we have seen a correlation between severe pronators and Achilles tears, regardless of the age of the athlete.

Prevention and rehabilitation.

The most important aspect in preventing and rehabilitation of Achilles injuries involves a comprehensive biomechanical examination of the lower extremity and the utilization of a proper orthotic device to control abnormal pronation.

How does a properly prescribed custom orthotic work?

A properly designed and executed biomechanical orthotic device puts the heel in a perpendicular position to the ground. It also levels the anterior facet of the calcaneus, so the talus cannot slide so far forward and medially, which creates an increase in uncontrollable pronation. Therefore, slowing the velocity at which pronation occurs. This is important in prevention, not only in Achilles issues, but it also protects the muscles of the leg, the ACL, the anterior hip, and the lower back from injury.

To schedule your appointment call our office at (610) 522-9200 or email us at leecohenassociates@gmail.com.

Dr. Lee S. Cohen & Associates, Sports Medicine Podiatry Center offers general podiatric foot and ankle medical care for individuals and their families, as well as specialized treatment for athletes relative to the lower body extremities, serving South Jersey and Philadelphia and surrounding areas with two convenient office locations in Ridley Park, PA. and Cherry Hill, N.J.