Updated: Aug 11, 2020
This is a common question we hear from Memphis athletes, particularly those who are runners-
"Why did wearing a boot not fix my Achilles tendinitis?"
Usually, the pattern we see is that the athlete has experienced consistent Achilles pain and has seen someone who recommends that they wear a boot to decrease what they suspect is inflammation by immobilizing the whole foot. Sometimes they wear the boot for 3-4 weeks, sometimes it's longer and closer to 6-8 weeks. Sometimes their foot feels better in the boot, sometimes it doesn't.
After the boot comes off and they try to get back into running, the pain instantly comes back. By the time runners come to see us for physical therapy, much time and energy have been wasted with no real change, and they're understandably very frustrated by the entire process.
Why did this happen?
Most of the time the goal of wearing a boot is to decrease inflammation because a practitioner assumed that the pain is from tendinitis (inflammation of the Achilles tendon,) and that immobilizing the foot will help decrease inflammation.
This can be misguided because oftentimes, inflammation is not the cause of the pain.
First, if the boot hasn't helped the Achilles pain, then the source of the pain isn't inflammation. Particularly when you're dealing with the Achilles, research has shown that if the pain has been there for a while, it's not an inflammatory reaction and is often the opposite.
We typically find that the root cause of Achilles tendinitis has to do with loading.
Either the tendon has been underloaded or overloaded, it's coming under stress, scarring inside the tendon is occurring, and the tendon isn't being put in enough of a healing environment to allow it the opportunity to heal itself. In many cases, limiting all motion inside of a boot isn't a healing environment.
Instead, we have to find the appropriate amount of stress/load to help the tissues heal themselves.
If they're underloaded or overloaded, we can't expect the injury to go away on its own.
A comprehensive and strategic treatment of strengthening the tendon and the muscles above and below it are necessary for pain relief and healing results. There can be many factors that are affecting the load your Achilles tendon is experiencing, and our physical therapists work on everything from flexibility of the ankle, foot, and big toe to strengthening into the leg and hip. We also help discern how your activity levels, whether decreasing or increasing, as well as footwear, could be contributing to the stress on your Achilles.
Most importantly, our physical therapists will help you get back into running and feel confident in your Achilles tendon for the longterm.
There are many factors to consider with persistent Achilles pain, especially in runnerse, and it's not generally something that will completely heal without strategic treatment that takes into account a full range of contributing factors.
If you're a Memphis runner who is experiencing Achilles pain, we encourage you to start physical therapy treatment as soon as possible to avoid what can become a chronic issue if not given the attention it deserves.
At 901PT, our physical therapists are very experienced in helping runners get back to their training schedules, speed work, and running hills after an Achilles injury. We believe that Movement is Medicine, and we can help you find the right kind of movement your body needs to heal from frustrating Achilles pain and get you back to the kind of activity you love!
We'd love to hear about what you're dealing with and offer you guidance and answer your questions about how we can help!