Know Exactly Where Your Achilles Tendon Hurts

Back view of L calcaneus 

I had right Achilles tendon pain earlier in the year. After doing some Alfredson protocol exercises, wearing the Strassburg sock and getting my colleagues and wife to treat me, I could run pain free. 

Yes, I still ran twice a week even though I had some pain while running. Some of that same pain came back during our recent holiday in Japan. I did not cycle nor run during the trip but did some skipping for the first few days of our trip. 

Then I came across an article (with nice pictures) of what makes up the Achilles tendon and how it attaches on the calcaneus (heel bone), pictured above. While skipping, my gastrocnemius (or calf) muscle, was used more than the soleus. I realized that this was what led to the recurrence of my Achilles pain.

The Achilles tendon is the largest/ longest tendon in the human body and is formed when the medial (inner) and lateral (outer) parts of the gastrocnemius and soleus muscles merges.

The authors dissected 12 fresh frozen leg specimens to find where the Achilles tendon inserts (or finishes) on the calcaneus in relation to their corresponding muscles. They also examined 10 embalmed specimens to confirm an observation on the retrocalcaneal bursa.  A bursa is fluid filled sac/ pouch that acts as a cushion and gliding surface to reduce friction.

The superficial part of where the Achilles tendon finishes is where the medial head of the gastrocnemius muscle attaches (in light blue) on to the lower facet of the calcaneus. The authors (like previous studies) found evidence that tendon of the medial gastrocnemius forming the superficial part of the Achilles tendon is continous with the plantar fascia. Like I written before, in order to get the Achilles tendon better, you need to treat the plantar fascia and vice versa.

The deep part of where the Achilles tendon finishes is where the soleus muscle attaches on the inner part of the middle facet of the calacneus, while the lateral head of the gastrocnemius muscle attaches (in red) on to the outside part of the middle facet of the calacneus.

In the space between the calcaneus and the Achilles tendon, a distinct 2 chamber bursa was present in 15 out of 22 examined specimens (9 out of 12 fresh frozen specimens and 6 of the 10 embalmed). The smaller shallow medial chamber is located in front of the soleus tendon whereas the lateral chamber is in front of the lateral head of gastrocnemius tendon.

Here's what amazes me. From the dissections, the authors found that the Achilles tendon rotates as it goes down the leg. Meaning the fibers from the medial gastrocnemius head forms the back aspect of the tendon while the anterior part of the tendon is formed by the lateral gastrocnemius head and soleus muscles.

This article was helpful as it helped me pinpoint exactly where my problem was and most importantly it helped deepen my understanding of the function of each muscular, connective tissue part of the gastrocnemius, soleus and the Achilles tendon and their clinical relevance in the treatment of Achilles and plantar fascia problems.

So, if you are still having problems with your Achilles tendon and it does not seem to be getting better, show your healthcare practitioner the topmost picture so they know exactly which part to take note of. If they don't you can always come to our clinics.

Reference

Ballal MS, Walker CR and Molloy AP (2014). The Anatomical Footprint Of The Achilles Tendon: A Caderveric Study. Bone Joint J. 96B: 1344-1348. DOI: 10.10=302/0301-620X.96B10.33771

Back From Mount Everest To Sports Solutions

Fresh from returning from her climb, PS came to our clinic today and presented me with an autographed picture of her on Mount Everest. Very kind of you PS, thank you very much indeed!

Here's a close up

Whilst treating her, she shared her stories from the climb, leaving me spellbound for more. It was really nice listening to her experience. Glad our clinic can be of help.

She also shared that she brought her Strassburg sock with her to Everest. So we decided that we will hold a raffle in her honor. The person who gives the best reason as to why they need a Strassburg sock will win one.

I'll let PS decide who gives the best answer on our Facebook page.

Here's the Strassburg sock you readers stand to win. Please go to our clinic's Facebook page and leave your comments. The winner will be announced end of this week on 160619. All the best!

Strassburg sock

Please like our FB pages and share the post.

Zamst HA 1 Running Socks

Another incentive for me to start running after my accident. I received a pair of Zamst HA 1 Running Heel/ Arch socks to trial. It's touted as being helpful if you have heel pain (or plantar fasciitis).

First impression was that it took some effort (compared to a normal pair of socks anyway) to put on the sock. It looks like any normal pair of socks but once you put it on you will begin to appreciate that there's more than meets the eye.

The socks are definitely thicker than your regular running socks, and they are built anatomically to fit your right and left foot separately. Using their proprietary fit and knitting technology, there is some stabilizing force on the heel and I can definitely feel it supporting the arch of my foot. There is also no pressure on the medial calcaneal tubercle (this is where the plantar fascia attaches and commonly where it hurts).

The elastic at the top of the sock also feels stronger than normal although it does not seem to trouble my Achilles at all.

Since my doctor forbids me to ride my bike outside for another 2 months, I rode on the stationary bike and ran for a few minutes (don't tell my wife) with just the socks sans shoes yesterday at the Sports Solutions rehab area. This is probably the only brick (or bike-run) workout I can do at the moment given that my doctor thinks I should not be running yet. There was decent support compared to being barefoot of course.

I also lent the HA 1's to my wife whose left plantar fascia acts up occasionally. She has not run with it yet but said she felt a lot of compression/ pressure on the dorsum of the foot (or top of the foot) whilst walking around the house with it. She felt the arch support it provided.

My impressions are that the Zamst HA 1 socks may be suitable for those who are running in minimalist/ barefoot type running shoes and would require some additional support under their arches. Of course, your correct running form still trumps everything else.

My own experience suggests using the patented Strassburg sock while you sleep to help with plantar fasciitis if there are no other contributing factors after you run with the HA 1's.

My very own Strassburg sock since 2004

And if you do have plantar fasciitis given that plantar fasciitis can be caused by many different factors, I suggest you come to our clinic and find what is causing your plantar fascia to hurt rather than just treating the pain.

* You can get the Zamst HA 1 Running Heel/ Arch socks from Progress Healthcare.