Patients often present with Achilles problems that come from direct injury, such as a hard landing whilst doing sports, or from, for example, running up a hill, stretching the Achilles and causing small tears to its insertion or along the body of the tendon.
If all is biomechanically in order, we can proceed with treatment, such as ultrasound,laser, deep tissue massage, hot/cold and rest. ( see my later article, "treatment for Achilles injuries ") .
However, there are those patients that present with Achilles problems that have had a slow onset; maybe a slight injury will bring on a bigger problem than we would have expected from the incident that precipitated their visit to us.
In other words, we need to look for a REASON that this occured. We need to wear our best" diagnostic detective hat" and look for why this small incident caused an out of proportion injury.
Before I proceed with any treatment, I always look at the posture of the foot.
A PRONATING foot will cause the Achilles to bow, like a longbow.
This causes a constant strain on the root of the Achilles at the heel, and may also affect the length of the tendon.
It becomes easy to see why a minor injury could start a bigger problem in the Achilles, as it is already weakened from the bow effect. Put simply, we have a case where the patient has merely added to the already existing tearing.
We therefore need to offer a prescription orthotic to correct the pronation, and will almost definitely have to add extrinsic rearfoot posting to straighten the Achilles and remove the source of the problem. In some cases we will need to add forefoot posting too.
Another consideration may be to offer heel lifts to both feet to take strain off the Achilles, at least until the injury has repaired and the orthotics can take over.( NB NEVER give a single heel lift as severe biomechanical imbalance will result, hurting the knees, hips and back ).
We can then proceed with treatments to heal the injury, happy that we have also taken away the cause firstly.
Another type of foot that can cause Achilles injury is the pes cavus / supinator where the achilles is tight and immovable on standing.
For this type of foot we may correct with orthotics, but may need a little LATERAL extrinsic posting to stop the supination. This type of posting is rare to use and should be avoided by the inexperienced prescriber.
These cases will almost definitely require heel lifting to remove the tightness from the achilles, and this can be built into the orthotic if boots or roomy shoes / trainers are worn, but building onto the shoe heels themselves are more often an easier answer.
As always, I recommend semi flexible prescription orthotics in all but the rarest cases, and ensure your practitioner is well versed in prescription orthotics.
Dr Les Bailey phd,DO,acopm,apta (int part). Les Bailey orthotics articles.
Dr Les Bailey / Les Bailey orthotics articles 2012, Woodmansterne, Banstead,Surrey
About Dr Les Bailey phd,DO, acopm.apta(int part)
Email to drlesbailey@
please phone 07801418080
Dr Les Bailey began in physical therapies in the early 1980,s qualifying in soft tissue massage,and later going on to qualify as an osteopath at the Northern school.
He gained his Doctorate (phd ) from OIUCM for a thesis on the treatment of plantar fasciitis using orthotics
He was awarded the teaching/lecturing diploma from the northern school of osteopaths in the early 1990,s
He also holds a diploma in foot biomechanics .
Les Bailey is author of "the laymans guide to foot and heel pain"
Dr Les Bailey works from his clinic near woodmansterne, Banstead in surrey.