This past weekend while vacationing with my family, I was introduced to Terry while we worked out at CrunchGym in Danville, CA. He is a close friend of Cindy, one of my dearest friends I’ve known for 20 years. Terry is a former elite power lifter and present fitness enthusiast. Terry approached me after our workout and respectfully asked for my medical opinion of a chronic heel injury that was significantly hampering his active lifestyle.
I was more that happy to help him and I think it will prove to be a useful example of a long-term dilemma experienced by many: “Is the pain in the back of my ankle Achilles tendonitis or Achilles bursitis?”
I’d like to share with you what I did with Terry by listening for 1 minute, asking questions for 1 minute and examining his lower extremity for 1 minute. This is just another reason why I’m so fortunate to be in the sports medicine profession and a proud member of PFATS. I’m very blessed to have the opportunity to change someone’s life by simply sharing what I love to do in just 3 minutes!
Complaints:
Terry noted lower Achilles pain behind and below the base of the Achilles tendon. Walking down stairs and ramps hurt, tight shoes made it worse and palpating the “back ridge” of the heel bone (calcaneus) increased the pain.
Terry was convinced he would need surgery and was actually calculating his downtime after surgery!
Exam Findings:
I found a tight calf muscle, a thick and firm Achilles tendon, and a puffy and tender swelling in the calcaneal bursa located at the bottom of the Achilles tendon and back of heel bone.
The “50 something” mature athlete was pain-free with a 1 legged calf raise, he noted that his calf and Achilles were stiff and sore upon waking in the morning but those symptoms quickly passed with walking. A bilateral comparison demonstrated symmetrical size and appearance with both calf muscles and feet alignment.
Diagnosis:
Retrocalcaneal bursitis, commonly referred to as Achilles bursitis.
Retrocalcaneal Bursitis Rehab Plan:
I like to keep my rehab plans simple when starting with an athlete at any age. I find this to improve the success rate significantly for two reasons. First of all, the athlete is more likely to be compliant and consistent with an easy to follow plan. Secondly, a simple 3 step plan will allow the athlete to clearer recognize improvements in their symptoms related to their rehab actions.
3 Step Plan for Achilles Bursitis:
- Loosen Up the Anchor – Massage and roller on his calf muscle 1-3 times per day will reduce the upward pull from his two calf muscles and his thickened Achilles tendon. A 1/4″ heel lift will decrease the pull of the calf and Achilles and help with symptoms of Achilles bursitis and Achilles tendonitis.
- Minimize the Pressure – Avoid the shoes and activities that put pressure on his lower Achilles and the back of heel bone. Terry told me he had a pair of running shoes that he loved but they put a lot of pressure on that area.
- Reduce the Swelling – Ice and lots of it. Ice massage, ice backs and ice baths are all great. As you know, I’m not big fan of taking medicine. I like to positively influence swelling and inflammation from the outside-in (ice, modalities and manual therapy) compared to those that look for a shortcut working from the inside-out (medicine and injections)
Take Home Points:
- The back of the ankle is a busy area and, although the Achilles tendon is a common source of pain in that area, injuries there can involve many types of tissues.
- The fear of surgery is common when pain becomes chronic and an active lifestyle is hampered. Find a trusted sports medicine resource quickly to help you get back to doing what you love to do: Being Active & Healthy.
- Improper footwear and poor progression of exercises are common factors related to non-professional athlete injuries. Focussing on having the proper fit with the right shoes compared to how the shoes looks will save your lots of $$ and downtime with useless injuries. This applies to you too, ladies. Dress shoes and workout shoes included.