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Feldenkrais Method
Achilles Tendonitis, Bursitis, Rupture; Plantaris Rupture

Achilles tendonitis is an inflammation of the Achilles tendon. See link: It may be caused by the strain of a high-speed contraction of calf muscles while running or jumping, particularly if the calf is tight. People with excess body weight are at greater risk as are those who walk and run more on their toes (the normal motion is heel to toe). Achilles tendon pain is usually felt in the back of the heel while walking or when rising up on tiptoes. Tenderness can be palpated usually mid-tendon or at times along the lower edges of the tendon above the insertion.

Achilles Tendon Bursitis can also cause pain at the back of the heel. There is a bursa between the tendon and the tibia called a retrocalcaneal bursa. (See At 1, 2) Here there will be no pain upon rising up on the toes, but pressure applied to the tendon towards the tibia while non-weight bearing, with the ankle in extreme plantar flexion (toes pointing down) will cause pain. There is another bursa called the postcalcaneal bursa that is located between the skin and the tendon, which is usually aggravated by tight fitting shoe backs.

Calf muscles are a very strong group of muscles that are a combination of the gastrocnemious muscle (two headed muscle on the outside, see At 3) and soleus muscle (beneath the gastrocnemious). (See At 4)

These muscles taper and end as the Achilles tendon, a tough, flat, ropey cord that attaches to the heel bone. (See At 5) Calf muscles point the foot downward, and are responsible for raising us up on our toes. In walking they help push us off the ball of our foot for the next step. Normal elasticity of these muscles helps our foot go flat when stepping down. Jumping also engages the calf muscles. These muscles are very active and can get very tight. For this reason runners are always encouraged to stretch them before and especially after running. The normal bend of the ankle is also important to normal arch and foot mechanics. One should have 5 to 10 degrees of ankle dorsiflexion (top of toes getting closer to the shin see clip At 6, 7).

If there isn't sufficient dorsiflexion then the arch will lower more than it should to allow the foot to flatten to the floor. So flexible calf muscles with adequate ankle dorsiflexion are key in normalizing most ankle and foot dysfunction.

Treatment Strategies:

Acute pain of Bursitis or Tendonitis Strain

  • Anti-inflammatory medication will help reduce pain with walking. See allopathic, homeopathic.

  • Reduce amount of walking for a few days to a week. If severe use assistive device such as a cane or crutches.

    • Use ice to the back of the heel no more than 20 minutes 3 times a day.

    • May use small lift in the heel area of shoe, this takes some of the strain off the tendon by shortening it (use in both shoes so as not to cause a longer leg on one side).

    • Wear supportive lace up shoes that have a slight heel, don't walk around barefoot.

    • Be sure that the back of your shoe is not rubbing your heel. If it is, cut the back of the shoe to get expansion.

    Sub-acute and chronic pain

    • Anti-inflammatory medication, as needed for pain. See allopathic, homeopathic.

    • Continue to limit time on feet, no walks longer than 10 minutes, no running or jumping.

    • Use moist heat applications to tendon area 20 minutes 1 to 3 times a day.

    • Kurashova neuromuscular techniques will help improve circulation to the healing tissue, restore elasticity to the calf muscles and tendon. This is crucial in preventing return of tendonitis.

      • When pain free, begin gentle, sustained 30 second, non-weight bearing stretches to calf with the knee straight as well as bent, progressing to weight bearing stretches if pain free. (Remember you need 5 to 10 degrees of ankle bend with your knee straight). (See clip At 8)

      • Ensure that you're wearing good supportive shoes when on your feet for 30 minutes or more.

        • Begin gentle weight bearing stretching of calves on the floor first, progressing to off the edge of a step, or on calf press machine. (See clip At 9, 10 but note that the rear foot must be turned forwards, as seen further in the clip)

        • Eventually remove heel lifts when you are walking without pain.

        • Strengthen your calves by going up and down on your toes or working on a calf press machine.

          • Doctors often offer cortisone injections. The injection itself is painful for several days and repeated injections tend to weaken tissue over time, so rather than be a first course of treatment, consider it if you are not making progress with other approaches.

          Achilles tendon rupture

          The Achilles tendon occasionally is completely ruptured. (See At 11) This is evident if a person has felt a sudden excruciating pain in the calf during activity that leaves them too weak to rise up on their toes standing only on that foot. Seek immediate medical attention. If treated within 10 days with proper immobilization, it has a chance of mending itself.

          Surgical repair and immobilization are often the course of treatment. Good follow up with manual therapeutic techniques will help normalize the muscle tissue after it is healed and gentle progressive stretching and strengthening will help restore function once the doctor has established that the repair is solid.

          Plantaris muscle rupture

          Imbedded in the back of the calf is also the very small Plantaris muscle. (See At 12) It does not contribute much to the function of the calf but is noticeable when it ruptures, as it often does in men 40-60 years old. This rupture usually feels like someone shot you in the calf out of nowhere. The trauma from a ruptured Plantaris muscle needs to be treated mostly for the pain it causes but long-term function is not affected.

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MovementWise Christine Inserra P.T.
Certified Teacher of the Alexander Technique & Feldenkrais Method
Physical Therapy serving Chicago and the Greater Chicagoland Area