A 45-year-old man arrived at Leading Edge Podiatry for assessment of suspected Achilles Tendonitis. He complained of pain in the lower left Achilles area which had been an issue for approximately 4 weeks. This gentleman was a healthy individual without any medical conditions and who took no medication. His typical running regime included running 4 days per week covering approximately 4-8 km with each run. He would occasionally complete a long weekend run of approximately 15km. He recalls completing a trail run which he thinks triggered the heel pain. The run was particularly hilly and on uneven surfaces. He notices some stiffness and pain when he tries to walk on his left leg each morning after getting out of bed. The patient explains that in the past he has experienced plantar fasciitis in his left foot about 3-4 years ago.
Patient’s Pain Symptoms
The patient reported that the heel pain was present in his left foot. The onset of pain was when running after approximately 15-30 minutes. He would struggle to finish the run and sometimes be forced to stop. He would also report that it was very painful again when he finished exercising. It would sometimes have residual pain for the remainder of the day.
Examination and Assessment
The podiatrist carried out a thorough examination, beginning with a comprehensive history-taking. The patient’s feet were examined and palpated; the pain was worse when squeezing the Achilles tendon. There was a subtle but visibly noticeable lump in the Achilles tendon. His running shoes outsole appeared worn severely. The podiatrist also assessed the patient’s range of motion and strength in the foot and ankle joint, and the flexibility of his lower leg and foot muscles, ligaments, and tendons.
The podiatrist conducted a biomechanical assessment and gait analysis as part of his diagnostic process. The patient demonstrated significant overpronation in his left foot but minimal in his right.
Diagnosis and Treatment
The sports podiatrist diagnosed the patient with Achilles tendonitis. The patient was advised to rest from running for a few weeks and to avoid any other activities that caused pain. The podiatrist recommended a course of dry needling to improve his calf’s range of motion. Achilles taping was applied to reduce strain on his Achilles. An exercise program was prescribed initially foam rolling of calves, and spikey ball massaging the soles of his feet. The patient was also fitted with custom-made orthotics to support the arch of the foot and reduce the strain on the Achilles tendon. The patient was advised to replace his running footwear and purchase trail running shoes to avoid ankle instability issues.
After 4 rounds of dry needling, the patient reported a significant reduction in pain and was able to return to running. The patient was advised to progress his exercises to provide strengthening and conditioning. Taping was still applied for the first month of running and to wear the orthotics as directed. If his pain was to persist the next recommended form of treatment is to consider shockwave therapy.
