When is Achilles Tendonitis not Achilles Tendonitis? When it is Retrocalcaneal Bursitis
February 13, 2010
Do you experience pain at the back of your heel? Is the back of your heel red and swollen? And you were told that it might Achilles Tendonitis? But so far treatment for Achilles Tendonitis does not seem to be working? You might be suffering instead from Retrocalcaneal Bursitis.
Background
www.merck.com
This condition is often mistaken for Achilles tendinitis but it can also occur in conjunction with Achilles tendinitis.
Signs and Symptoms
In retrocalcaneal bursitis, pain at the back of the heel is the main complaint from patients. Pain may worsen when tip-toeing, running uphill, jumping or hopping. Often, those who are accustomed to wearing high-heeled shoes on a long-term basis may also complain of pain at the back of the heel when switching to flat shoes. This is because when in high-heeled shoes, the calf muscle and the Achilles tendon are in a shortened position. Switching to flat shoes would cause an increased stretch to the calf muscle and Achilles tendon, irritating the Achilles tendon and the retrocalcaneal bursa. Other symptoms may include redness and swelling at the back of the heel.
What leads to Retrocalcaneal bursitis?
There are several factors which can lead to a person developing retrocalcaneal bursitis. In athletes, especially runners, overtraining, sudden excessive increase in running mileage may lead to retrocalcaneal bursitis. Tight or ill-fitting shoes can be another causative factor as they can produce excessive pressure at the back of the heel due to restrictive heel counter. A person with an excessively prominent posterosuperior aspect of the heel bone (Haglund deformity) may also have a higher predisposition to retrocalcaneal bursitis. In such individuals, pain would be reproduced when the ankle goes into dorsiflexion.
How do we tell that it is not Achilles Tendonitis?
Careful examination by your physician or physiotherapist can determine if the inflammation is from the Achilles tendon or from the retrocalcaneal bursa. Tenderness due to insertional Achilles tendinitis is normally located slightly more distal where the tendon inserts into the back of the heel, whereas tenderness caused by the retrocalcaneal bursa is normally palpable at the sides of the distal Achilles tendon.
Diagnosis can be confirmed with an ultrasound investigation, MRI or CT scan.
Management
- During the initial acute phase of the condition, patients should apply ice to the back of the heel for 15 to 20 minutes and follow the R.I.C.E.R regime. Avoid activities that cause pain.
- Gradual progressive stretching of the calf muscle and Achilles tendon is also advocated.
- Changing the footwear. Wearing an open-backed shoe may help relieve pressure on the affected region. For those whose symptoms were caused by a sudden change from wearing high-heeled shoes to flat shoes, the temporary use of footwear with a heel height in between may be helpful.
- Inserting a heel cup in the shoe may help to raise the inflamed region slightly above the shoe’s restricting heel counter and relieve the pain. It is advisable to also insert the heel cup into the other shoe to avoid any leg-leg discrepancies that can lead to other problems.
- Training frequency and intensity should be gradually progressed with adequate rest between trainings.
Train Proprioception to Prevent Sprains
December 17, 2009
Hi, I hear from my personal trainer that i need to train my proprioception because of my ankle sprains. What is proprioception and how is it relevant to my ankle problem? – John Koh
What is Proprioception? Read more
Exercises for Ankle Sprain
September 22, 2009
Following our article on the most common ankle sprain, this article focuses on the rehabilitation exercise that will help with an ankle sprain.
Rehabilitation
Proper rehabilitative exercise is crucial in ensuring that new tissues are laid down and aligned properly during the healing phase. Rehabilitation exercise should comprise of four components: (i) range of motion exercises, (ii) progressive muscle-strengthening exercises, (iii) proprioceptive/ balance training, and (iv) activity-specific training.
Below are some recommended exercises that you can do at home. It is necessary to progressively increase the intensity of these exercises. Discuss with your sports physiotherapist so that they can progress you safely. Read more
Inversion Ankle Sprain
August 23, 2009
The ankle is one of the most common sites for acute musculoskeletal injuries accounting for 75 percent of ankle injuries. Among athletes, ankle sprains are the most common injury yet they are so often mistreated or not treated at all. A consequence of this neglect is a lasting weakness, an unstable joint and repeated sprains. This article will look at the most common ankle injury and its acute management.
Inversion Sprain
Inversion ankle sprains occur when the foot turns in or out to an abnormal degree relative to the ankle. The most common mechanism of an ankle sprain is a combination of plantarflexion and inversion where the foot is pointing downward and inward. The following video is an example of that.
Lateral Ligaments
The lateral ligaments are involved in an inversion ankle sprain and hence most commonly damaged. These ligaments are on the outside of the ankle, which includes the anterior talofibular (ATFL), calcaneofibular (CFL) and posterior talofibular ligaments (PTFL). Injury to the ATFL is the most common. When both the ATFL and CFL are injured together, ankle instability will be more noticeable. The PTFL is the strongest of the three ligaments and is rarely injured in an inversion sprain.
source: Flickr – Northcoast Footcare and Core Concepts
Sprain = Overstretched ligaments
Ligaments are like tough rubber bands that help to provide stability to the any joint by limiting movement. When one or more ligaments is stretched beyond the normal range, a sprain results.
Ankle sprains range in severity from Grade I to Grade III and is useful for more than classifying the severity of the injury; it also directs treatment and prognosis.
| Grade | Signs & Symptoms |
| Grade 1 | Ankle sprains are painful, but they have no increased laxity when compared with the uninjured side. This correlates with mild stretching of the ATFL. |
| Grade II | Ankle sprains are painful and have an increased laxity on testing. This correlates with a complete tear of the ATFL and a partial tear of the CFL. |
| Grade III | Ankle sprains are usually painful and have an unstable ankle joint on examination. This correlates with complete ruptures of both the ATFL and CFL. |
Causes
Common causes of ankle sprains include stepping up or down on an uneven surface, particularly when wearing high heels; stepping wrong off a curb or into a hole. In athletics, common causes include landing wrongly after a jump shot and having to make quick directional changes as in tennis, soccer, and netball.
In essence, when the ligaments and muscles are not able to support the joint at a certain position, the ankle gives way. This is why training the muscles is very important when ligaments are “loose” or overstretched.
Management
Treatment and rehabilitation starts the moment you have sprained your ankle. It is recommended that you start the R.I.C.E.R regime as soon as possible after the injury. An anti-inflammatory drug may be recommended and crutches provided for a few days if the ankle is too painful to bear weight.
Immobilisation using a brace or a cast can provide the injured ligaments with the rest they need to heal and reduces the risk of aggravating the injury. However, immobilisation should not be prolonged and must be followed within a week by exercises that prevent joint stiffness and muscle wasting.
Orthotics for Achy Feet
August 16, 2009
"Dear Sir, I am a lecturer and an avid, regular sports player. My feet aches every week and I go for regular foot massages. I did an analysis on my feet during one of the orthotic analysis booths at some shopping centre which reported I have high arch and pronation. I wonder what can be done to correct that and reduce my achiness? " - Mr Ho
How to tell the difference between an ankle sprain and a fracture
July 27, 2009
This is a brief video on how to tell the difference between an ankle sprain and an ankle fracture. If you are thinking of taking an X-ray to confirm if it is a fracture, the Ottawa Ankle Rules has a guideline to check if you need an x-ray.
Simple Exercises For Plantar Fasciitis Sufferers
June 26, 2009
In an earlier post, we discussed on what plantar fasciitis is about, including the causes, symptoms and treatment options available. If you think you might be sufferring from plantar fasciitis, read on and find out more about the exercises that you can do to help ease the pain in your foot!
Plantar Fasciitis – Pain In The Heel!
June 17, 2009
What is plantar fasciitis?
Plantar fasciitis is a term given for the painful and inflamed flat, fibrous band of tissue (also known as the plantar fascia or plantar aponeurosis) that connects your heel bone to your toes. The fascia acts as a shock absorber and supports the arch of the foot. With plantar fasciitis, there is an excessive strain placed on the fascia. This excessive strain causes tiny tears in the plantar fascia exceeding the body’s capacity to recover, resulting in inflammation. In turn, this causes weakness, irritation, swelling and pain along the plantar fascia, especially in weight-bearing activities.
Ankle Replacement Surgery
June 9, 2009
An ankle replacement surgery is where the joints of the ankle are fitted with a prosthesis or an implant to replace the existing worn out joints. It is usually recommended for the elderly and relatively inactive person as one of the major complication from such a surgery is loosening of the ankle joint due to overuse. After the surgery, you will be placed on a cast to protect the joint for a period of 6-12 weeks before you can gradually put weight on it. An ankle replacement can generally last 5 – 10 years depending on the activity level of the patient.
Achilles Tendinopathy
May 25, 2009
Pain in the back of the heel is a very common complaint amongst athletes whose sports require quick, sudden movements. This pain is due to the sudden, forceful pull of the calf muscle onto the Achilles tendon which, in turns, pulls onto the calcaneal bone (heel bone) of the ankle.
-
Popular Articles
- Posterior Pelvic Pain (Sacroiliac Joint Pain) in Pregnant Women
- Nerve Stretches
- 5th Metatarsal Fractures
- Sports Taping - Knee
- Multifidus - Smallest Yet Most Powerful Muscle
- Myofascial Release
- Sports Taping - Wrist
- See a Therapist
- Jaw Pain - What other causes besides the teeth and jaw?
- Manual Therapy - Spinal Vertebra Mobilisation
- Pregnancy - Changes and Aches
- Belt Up Your Unstable SIJ
- Does Bad Posture Lead to Scoliosis?
- Patellar Tendinitis
- Lumbar Spinal Stenosis
- Pain Relief Medications: An Overview
- Sports Taping - Ankle
- Iliotibial Band Friction Syndrome
- Simple Exercises For Plantar Fasciitis Sufferers
- The Buckling Knee
See the Therapist
For an appointment to consult with one of our physiotherapist for treatment, kindly call us at : +65 6226-3632 (4 Lines)
or SMS us at +65 9232 2661 or email us at enquiry@coreconcepts.com.
Find out more about our various divisions at group.coreconcepts.com.sg/divisions.
Ask the Specialists
"Hi MCR, I keep hearing about ultrasound therapy but I get confused with the seemingly different answers I get about them. There appears to be one for healing... Read more »
If you have an question, feel free to drop us line. If the answer to the question is something more than a few people would be interested in, we will feature it.
-
RSS Feeds
Editorial Team
Editor
Chng Chye Tuan, B.Hsc(physio)
Accreditation
|
|
Blog Listing
Top pain blogs
