Tendon injury and stress, plantar fasciitis, heel spurs

Tendon injury and stress, plantar fasciitis, heel spurs

Runners and ballgame athletes often experience pain in their Achilles tendon or the plantar fascia, especially in connection with changes in training (e.g., preparation for an event such as a marathon). The two closely related structures can cause severe pain, both under stress and at rest. Pain is often greatest when taking the first steps in the morning after getting out of bed. Affected patients often describe a “tearing” sensation. In most cases, both pathologies arise from a shortening of the calf muscles, which then chronically overloads the Achilles tendon and/or plantar fascia. In some cases, chronic ankle instability can aggravate this strain. With the Achilles tendon, a distinction is made between the middle area and the site of attachment. A tender, spindle-shaped thickening often occurs in the middle area. The transition from chronic (para-)tendinopathy to an intratendinous partial rupture is fluid, and it is not possible to achieve an accurate clinical or radiological assessment of tendon stability. Chronic tendinopathy at the site of attachment can also lead to calcification of the tendon and the formation of a dorsal heel spur. Thickening of the tendon causes impingement, which can aggravate the pain. Another cause of pain around the Achilles tendon insertion is intrinsic impingement due to an enlarged heel bone (Haglund bump), which occurs when a raised heel bone presses the tendon from the inside. Chronic stress of the plantar fascia due to shortened calf muscles can also irritate the fibers at the base, leading to calcification and a plantar heel spur. The fundamental therapy for these pathologies is consistent physiotherapy with stretching exercises and extrinsic training of the calf muscles. A relatively new but very effective approach is Heavy Slow Resistance Training, which puts a heavy load on the tendon to stimulate the healing process. Fascia therapy can be very useful as well. Focused shock wave therapy can be applied to the Achilles tendon attachment area to activate regenerative processes. ACP therapy has also proven useful as a supplement to chronic plantar fasciitis treatment. If conservative therapy is unsuccessful, various surgical options are available for chronic tendinopathy of the Achilles tendon. In chronic mid-range (para)-tendinopathy, tendoscopy with decompression and synovectomy of the tendon can result in rapid improvement. If a Haglund bump is painful, endoscopic synovectomy and exostosis removal can decompress the tendon without compromising stability. In the case of chronic attachment tendinopathy with a dorsal heel spur, open surgery to remove the spur and resect tendinopathic parts is necessary if conservative treatment is unsuccessful. Depending on the size of the spur, it may be necessary to detach a larger section of tendon from the bone. In this case, the tendon must be reaffixed with bone anchors, and a walker must be used for six weeks following the operation to ensure that the tendon heals properly.