We'll talk about Achilles tendinosis and why we have it. This patient was on the golf
course walking on hard surfaces. Had this initially a few years back but went away,
now it's come back. And the question is why is it happening? Well here's the ugly truth about this
Achilles tendinosis. It usually happens around this area. There's a couple of different areas
where Achilles tendinosis can happen. Tendinosis meaning chronic versus tendinitis which is an
acute issue, a flare-up. Sometimes people have it right here where the Achilles tendon goes into
the heel bone itself where it goes and attaches but most of the time the chronic tendinosis or
degenerative tendinosis happens between here and here which is exactly where this patient feels
the pain. And this -- the reason for this one is because sometimes people can have a spur in
there or degenerative tendinosis right here but a lot of times they have a spur in the Achilles
tendon. This is not the case in this situation. The case in this situation is that there's blood
supply coming down here and there's blood supply coming from the bottom up, from the bone, from the
Achilles itself, but mainly from the arteries down here coming up, the arteries up here is coming
down. In this area between here and here there's a void, there's not as much blood going into that
particular area so it's coming up, coming down over here. Unfortunately this is the Achilles
heel of your Achilles heel. And that's where players -- football players -- even professional,
you know, up to the professional level so it's not a matter of you being weak or you not exercising
or any other reason. Professional players even have this rupture spontaneously at that site
just because of the lack of blood supply in that area. But right now even though she complained it
has pain here, it's very minimal so the prognosis is good for conservative care. Conservative care
would include at this stage just some physical therapy as well as something called Voltaren
gel, it's an anti-inflammatory gel that she's going to rub on here about three times a day,
it would help with the swelling. Light stretching exercises that we have a video on also about how
to stretch the Achilles tendon. Rest, ice, compression, and elevation -- the usual
rice R-I-C-E can help with that too. This should resolve about anywhere from 6-8 weeks with proper
physical therapy and the proper home care and proper stretching at home. Any other questions?
"No, we're good, thank you."
We covered everything, right?
"We did."
Now we're going to do the calf stretch. Go ahead, let's start the calf stretching. Okay bend your
front knee, you want to get the heel to the ground, the heel to the ground and you want to
stretch. Now, a little trick to this stretching strategy is point your toes in, point your toes
in when you do it. That's going to strengthen -- that's gonna cause you to stretch your Achilles tendon
more. Now if you put your toes out towards the outside here's the problem. Now stretch. You see
the arch is flattening so you're really flattening out that arch when you point your toes out. You do
not want to do that, you want to stretch that Achilles so you want to go ahead and bring your
toes in and stretch. Now another another trick -- now you're going to notice, we'll gonna do another
stretch now, that's stretching out your calf muscles. Now there's two muscles here, there's
a gastrocnemius and then there's a soleus muscle. Soleus is on the inside. Soleus does not cross the
knee joint. The gastrocnemius crosses the knee joint. So basically when you're doing this
stretch, you're only stretching one out of the two muscles. So what you want to do, now you want to
bend this knee and sit back, and sit back towards me, right here, come back, right there and stretch
your knee right there, bend your knee right there. When you bend your knee and stretch you're
stretching out that soleus muscle. So those are the two different stretches that you definitely should
do. Again, three sets of ten. Let's switch, let's do that again. Now a lot of people do when they
stretch, they stretch it the wrong way. We need to turn that foot in. And stretch. Okay, very good.
Okay now we're back. This is the last and final stretch here that's going to help you with your
heel pain. Go ahead, this is a foot rocker, you go ahead and put your heel on there and
you just sit back and relax but don't fall. Stretch, stretch, stretch all the way back.
This will stretch out your Achilles tendon. Again the Achilles is attached to the plantar
fascia. You want to go ahead and give it a nice stretch right there. Again you do this
for about five or ten minutes alternating between legs or do it for a few seconds,
stop, do it for a few seconds, stop, and this will help stretch out your calves.
Okay here we go. This is called a night splint. This is a splint that we put on the patient,
this will help with the pain first up in the morning or getting out of a car or
first step getting out of a chair that's usually a patient's complaint. Scientifically it's called
post static dyskinesia, pain after you've been in a static position for a long time. Basically what
happens is that plantar fascia contracts and when you first take that first step it gives
you an ouch when you take that first step, your foot is here, you take your first step, ouch,
you sprain that plantar fascia. So what this does is it keeps the foot in a stretch position so you
don't have that acute stretch upon the first step. The goal of this is not to give you a
hyper stretch but really the goal of this is to hold your foot in about 90 degrees so that way
when you're sleeping or resting, the foot does not drop like the other foot over there and the
plantar fascia contracts. That's where the pain comes from, from that first step in the morning.