Most cases of Achilles overuse injuries and posterior heel pain are managed conservatively. Kvist23 has reported the most common cause as training errors. Modification of activity or complete rest should be the initial management. Depending on the severity of symptoms, an individualized program should be devised. The key is to allow cross-training, which will keep the athlete in shape; this includes activities such as stationary biking, water therapy, and aqua jogging. As symptoms are diminished, the athlete can advance to the elliptical machine, stair climber, and the NordicTrack as a stepping-stone before resuming running.
If symptoms are milder, then training adjustments are made, including a temporary termination of interval training and hill workouts. The training surface must be addressed as well. If the surface is hard or sloped, it must be changed to a softer and flatter surface. Nonsteroidal anti-inflammatory medications are helpful in acute cases of retrocalcaneal bursitis or paratendonitis. In addition, a course of physical therapy, addressing stretching and strengthening, can be advantageous. Stretching should be executed before and after exercises with the knees both flexed and extended. Other modalities that may be helpful include ice, massage, iontophoresis, and phonophoresis. Schepsis et al18 noted that patients with chronic symptoms had limited passive dorsiflexion and benefited from passive static stretching exercises. They also found that in some cases a night splint to hold the foot and ankle dorsiflexed to neutral for 6 to 8 weeks was helpful to maintain passive dorsiflexion. Approximately 10% of patients with retrocalcaneal bursitis will fail conservative treatment.
Biomechanical or alignment problems that are causing excessive stress on the Achilles tendon must always be addressed. Orthotic devices may be useful in correcting malalignment problems to keep the foot and ankle in a neutral position. Gross et al24 studied long-distance runners who were given orthotics for their lower extremity complaints. About 20% had a diagnosis of Achilles tendonitis, and of those patients, 75% had great improvement or cure with orthotic shoe inserts. Orthotic devices are most helpful in correcting hyperpronation and leg length discrepancies. Also, a one-fourth- to one-half-inch heel pad built into the running shoe may be helpful in reducing stress on the tendon in patients with normal alignment.
Finally, after training errors and malalignment problems have been addressed, a program of calf strengthening should be instituted. Eccentric, heavy load calf exercises have been shown to be quite effective in chronic or resistant Achilles overuse syndromes.25 Also, maintenance stretching should be continued.
Chronic paratendonitis occurs when symptoms are present for greater than 3 months duration. Nonoperative measures are less successful if there is a delay in treatment. Brisement or dis-tention of the paratenon-tendon interface with lidocaine or other solution can be used in refractory paratendonitis. This is a mechanical lysis of adhesions between tendon and paratenon that occurs by the rapid infusion of 5 to 15 mL of local anesthetic or saline into the peritendinous space. Brisement can be done in the office and can possibly eliminate the need for surgical intervention. There is a 33% success rate with this procedure.
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Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.