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Achilles Tendonitis - Symptoms and Treatment for Runners

Achilles Tendonitis - Symptoms and Treatment for Runners

Achilles pain is common amongst runners. It is sometimes referred to as achilles tendonitis Achilles tendon(tendinitis), tendinosis, tenosynovitis, tenovaginitis and a few others which are technically all slightly different conditions, but the term achilles tendinopathy is used as an umbrella term to encapsulate all achilles overuse injuries.

What are the Symptoms?

Achilles tendinopathies tend to start as an aching and stiffness in the tendon at the back of the ankle, especially in the mornings and after periods of inactivity. If you continue to run, pain may start to develop during the run and the area may become tender to touch. You may start to notice that the tendon appears thicker and sometime redder in colour compared to the tendon on the other leg. Pain then becomes more frequent during daily activites and develops earlier in your run.

What is it?

The achilles tendon is the thick tendon at the back of the heel. Tendonitis is an inflammatory, overuse condition. However, recent research has shown that there are rarely inflammatory cells present in the tendons of those with gradual onset achilles pain. Instead, the condition is believed to be degenerative in nature with small microtears in the tendon and collagen disarray.

All of the term mentioned above actually mean something very slightly different - for example tenosynovitis is actually inflammation of the sheath surrounding the achilles tendon. However, in a clinical setting it is virtually impossible to tell the difference between each of these specific types of achilles injury and so they tend to be grouped together under the term tendinopathies. Only imaging studies such as an MRI scan or ultrasound will be able to determine the exact cause of pain. The treatment for these conditions is all much the same so in most cases, it is not necessary to distinguish between the forms.

What causes achilles tendinopathy?

As with most running injuries there are multiple potential causes. With achilles tendon pain the most common causes I come across are tight calf muscles and overpronation. Often there are also training errors or another activity which has caused a flare up.

It's all very well saying that tight calf muscles cause achilles tendonitis, but why are the calf muscles tight? You can loosen the calf muscles with stretching and massage, but when you return to running the pain will return as the calf muscles gradually tighten again in response to whatever caused them to tighten in the first place!

Again there can be many causes. Wearing high heeled shoes all day; A previous injury to the ankle or lower leg and a muscle imbalance around the hip are the most common problems I come across. Whilst the first two make sense, the last statement here may sound a little crazy. How come something in your hip cause your calf muscles to be tight? Here's an example:

Tight hip flexors mean the stride length is shortened; Because of this the heel lifts up earlier; This means there is less eccentric loading of the calf muscles; This means the leg swings forwards with less force; This forward swing is required to naturally supinate the other foot; Less natural supination means the supinating muscles must work harder = tight calf muscles!

Oversupination can cause tight calf muscles but overpronation can place additional torsional forces on the achilles tendon as well. So making sure you have good arch supporting shoes and suitable orthotics if required is very important in avoiding this condition.


The treatment of achilles tendonitis / tendinopathy, as with most running injuries, starts with rest from running and excessive walking. Ensure you wear good supportive shoes at all times and initially ones with a small heel are ideal to raise the heel and reduce the stretch on the tendon. Altenatively a small heel raise can be added to the shoes.

Applying ice to the tendon will help ease pain, swelling and inflammation in the early stages. A Doctor may also recommend anti-inflammatory meds.

As long as it is comfortable to do so, start stretching the calf muscles. Ensure you stretch both the Gastrocnemius and Soleus muscles. You do this as follows:
Standing facing a wall, with the leg to be stretched behind and the front leg about a 2 feet from the wall.Keep the back knee straight and heel on the floor as you lean forwards, pushing against the wall with both hands.If you can't feel a stretch in the calf, either move the back footfurther back or try pushing the knee backwards as if trying to overstraighten it.After holding this stretch, then move the back leg a bit closer in towards the front leg and bend both knees.Squat down as low as possible, again keeping the heels down, but shifting the weight towards the front of the foot.This should feel like a stretch lower down - near the tendon.
Stretching should be held for 30 seconds for each muscle and repeated 2-3 times, 3-5 times a day. It is really important to stretch these muscles regularly as increasing the flexibility of a muscle group takes a lot of hard work.

If you have access to a sports therapist, sports massage is great for the calf muscles and can also be applied directly to the achilles tendon. This is known as frictioning and is good for increasing blood flow and breaking down adhesions in the tendon. Electrotherapy such as Ultrasound in also often used and whilst there is limited evidence to confirm its effectiveness, many therapist, myself included, find it effective in a clinical setting.


The strengthening protocol recommended for achilles tendonitis is known as Alfredsons eccentric loading protocol. This uses eccentric heel drop exercises to strengthen and stretch the achilles tendon. This has been shown as the most effective way of increasing the tensile strength of the tendon.

To perform a heel drop:
Stand on a step on one leg, with the heel hanging off the back of the step.Start in a heel raise position, up on the tip toes.Slowly lower the heel down to below the level of the step.Then place the other leg on the step and riase back onto tip toes using both legs.Return to one leg and repeat the heel drop.
Alfredsons protocol involves a large number of reps and working through pain, which personally I have not had a lot of luck with and find clients reluctant to continue through the pain. I would personally advise starting with just 10 reps every other day and gradually increasing the reps / sets performed.

If you haven't had a gait analysis, this is worth doing as it will check if you have the right running shoes and day-to-day shoes for your foot shape and movement pattern. If necessary, change running shoes or insert insoles or orthotics to reduce overpronation.

Return to running

Continue with stretching / strengthening / massage until day-to-day symptoms disappear. Only at that point can you consider returning to running. When you do, start with a very short run, 10 minutes max. Stretch the calf muscles before and after and rest for 3 days following exercise. If ther is no pain at the time of run or in the three days after, try another short run and repeat the 3 day rest period. If again this is ok, add another 5 minutes to your run. Gradually increase in this manner, always continuing with stretching and strengthening exercises, maintaining regular sports massage treatments and wearing supportive footwear and appropriate running shoes.

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Bunion Night Splint -

Bunion Night Splint -

APEX is a division of Aetrex Worldwide, Inc. Comfort shoes, orthotics, insoles, shoe inserts, comfortable shoes, womens shoes, healthy shoes
Founded in 1946, Aetrex is one of the fastest growing companies in the comfort footwear industry and is widely recognized as the global leader in comfort and wellness footwear products. The Aetrex mission is to create the healthiest most comfortable shoes on the market today. With fashion, function and quality at the forefront, Aetrex designs and manufactures casual, dress, sandal, athletic therapeutic and comfort footwear for both men and women. All styles are crafted with care to meet the highest standards in design, incorporate cutting edge technologies and offer unmatched customization and adjustability.Originally known for the landmark development of arch supports, orthotics, and medically-oriented footcare products, Aetrex has come a long way to become one of the leading footwear companies in the US and around the world.Today, Aetrex is proud to offer fashion forward styles with innovative features designed to help you feel great on your feet and promote a healthy and active lifestyle.Aetrex is also renowned for its over-the-counter Lynco Orthotics and shoes inserts that are recognized as the #1 orthotic system on the market today. Recommended by doctors and pedorthists worldwide, Lynco Orthotics offer unsurpassed comfort, support and proper body alignment. Available in a variety of styles, they provide you with a custom selected solution designed specifically for your foot type and footwear style.Although footwear and orthotics are a major focus for Aetrex, the company has also pioneered an industry-altering digital foot scanner, the iStep. This patented foot scanning technology is designed to accurately measure foot size, arch type and pressure points in a matter of seconds. The technology immediately custom selects the ideal footwear and orthotics for your feet. Launched in 2002, iStep foot scanner is the leading digital foot analysis system, and is offered as a free service to consumers at thousands of locations throughout the world.Orthotics, comforts shoes, comfortable shoes, womens shoes, shoe inserts, shoe orthotics, ...

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Warner Orthopedics & Wellness - Diagnosing your Achilles tendon pain – Increase your awareness and take action!

Warner Orthopedics & Wellness - Diagnosing your Achilles tendon pain – Increase your awareness and take action!
Home >> Orthopedics >> Diagnosing your Achilles tendon pain - Increase your awareness and take action!January 8, 2014Dr. WarnerOrthopedicsID-100102442
So what is causing your Achilles tendon pain? It's possible you are suffering from what is called what is called Achilles tendinosis. Your Achilles (uh-KIL-eez) tendon is a band of tissue that connects the calf muscles at the back of your lower leg to your heel bone. Achilles tendinosis describes the degeneration of this tissue over time. The cause? Well, that may vary.

Achilles tendinosis is often a running injury or other sport-related injury resulting from overuse, intense exercise, jumping, or other activities that strain the tendon and calf muscles. But don't despair! But do not despair! Most cases can be treated with consistent, relatively simple care from your own home after a consultation with your doctor. But before self-medicating, it's first important to have your Achilles tendon pain properly diagnosed!

What are the signs and symptoms?
Achilles tendinosis may begin with inflammation of the tendon that links your leg muscles to the back of your heel bone. The most common sign of the condition is Achilles tendon pain that develops gradually and worsens over time. Signs and symptoms of Achilles tendinosis include:
Mild ache or pain at the back of the leg and above the heel after running or other sports activityEpisodes of more severe pain associated with prolonged running, stair climbing or intense exercise, such as sprintingTenderness or stiffness, especially in the morning, that usually improves with mild activityMild swelling or a "bump" on your Achilles tendonA crackling or creaking sound when you touch or move your Achilles tendonWeakness or sluggishness in your lower leg
So when is the right time to see a doctor? If you are experiencing pain around an Achilles tendon or heel, it's the right time to call your doctor. The pain may be caused by tendinosis, inflammation of other nearby tissue, or other forms of tissue damage. Therefore, it's important to obtain a timely diagnosis and appropriate treatment. If the pain or disability is severe, seek immediate care.

What can you expect from your doctor?
If you're experiencing Achilles tendon pain and other symptoms of tendinosis, you'll likely begin by seeing your family doctor or general practitioner. You may be referred to a doctor specializing in sports medicine or a specialist in disorders of bones, tendons and joints (orthopedist) or a specialist in physical and rehabilitative medicine (physiatrist).

Prior to your visit, it's helpful to reflect on this checklist of questions regarding your symptoms and factors that may be contributing to your condition. Be prepared to answer the following:
When did pain or other symptoms begin?Are symptoms worse at certain times of day or after certain activities?Does the pain lessen with rest?What is your normal exercise routine?Have you recently made changes to your exercise routine, or have you recently started participating in a new sport?What have you done to alleviate pain?What type of shoes do you wear for various activities?
In turn, here are some questions you can ask your doctor at the appointment:
What is likely causing the pain?What are my treatment options?How long is recovery likely to take?How much will I need to restrict my current level of activity or change my exercise routine?When do I need to see you for a follow-up appointment?
What kinds of tests assist with diagnosis?
A diagnosis of Achilles tendinosis is based on your answers to questions, results of a physical examination and, if necessary, imaging tests.

Exam - During the initial physical exam, your doctor will gently touch (palpate) the affected area to determine the location of pain, tenderness or swelling. He or she will also judge the flexibility, alignment, range of motion and reflexes of your foot and ankle.

Imaging tests - Imaging tests can help rule out other causes of symptoms and reveal damage to the tendon. Your doctor may order one or more of the following tests:
X-ray, which produces images of hard tissues, can help rule out other causes of symptoms.Ultrasound, an image of soft tissues produced with the use of sound waves, can reveal signs of inflammation and damage to the Achilles tendon. The images can also produce live-action images of the tendon in motion.Magnetic resonance imaging (MRI), which uses a magnetic field and radio waves to produce cross-sectional views or 3-D images, can show details about tissue degeneration and tendon ruptures.
Whether your Achilles tendon pain is mild or more intense, it's important to make yourself aware of your options and what you can expect from a visit to your doctor. Stay one step ahead by taking action and seeking a proper diagnosis!

(Image courtesy of stockimages /
Contact Dr. Meredith Warner Today!

Baton rouge_Female Orthopedist_foot doctor
Dr. Meredith Warner is a board certified, Fellowship Trained Foot and Ankle, Orthopedic surgeon practicing in Baton Rouge, Louisiana. Dr. Warner is committed to offering her patients an accurate diagnosis along with a comprehensive treatment plan in order to get them back to a pain free life. Dr. Meredith Warner specializes in the treatment of orthopedic issues, providing operative and non-operative treatment plans of orthopedic problems, including musculoskeletal pain such as chronic back, neck and foot pain, reconstructive surgery of the foot and ankle, arthritis, diabetic, hammer toe, bunion, wound care, work injuries, fitness and nutrition and osteoporosis issues.

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Biology professor tries to cure athlete's foot - The Breeze: News

Biology professor tries to cure athlete's foot - The Breeze: News

While drugs are the typical means to combat harmful bacteria, JMU biology professor Reid Harris is working to replace the chemicals with the use of good bacteria to help fight off athlete's foot.

Harris has been working since 2002 with probiotics which are small bacterium that have been previously used to help regulate digestive tract issues. His research has primarily focused on combating a fungus that has been killing off various amphibians around the world.

"[Amphibian chytrid fungus] is the biggest disease targeting frogs and amphibians around the world," Harris said.

According to Eria Rebollar, biology professor and one of Harris' faculty assistants, says the fungus infects frogs by growing inside of the amphibians' skin before eating away at the outer layer. This affects the frog's ability to breath, usually ending in its death.

Harris and his team have been experimenting on frogs infected with the fungus by using probiotics as a way to combat the infection.

"[Using evolution to our side] and using it to help compete against the skin fungus for dominance on the skin," Harris said. "The treatments have been proven successful in amphibians and in petri dishes to combat the fungus. This is a spin-off of that research that could become applicable in human probiotics."

Harris, along with his research partner, biology professor Kevin Minbiole, began formulating an idea to develop a probiotic that could be used to combat athlete's foot, a fungus that infects humans.

"Looking at current products for treating some infections, drugs are not 100 percent effective at fighting some infections," Harris said. "The idea of probiotics are augmenting a good antifungal bacteria that we already have on our skin. This produces a very effective molecule that could fight off fungus."

A benefit to this method of fighting athlete's foot is how it is administered. The cream will allow the medicine to get into hard-to -reach areas such as under the toenail. The cream is available over the counter Harris said.

Harris said that using the techniques they developed on amphibians, they could develop a similar solution for humans and made safe for market sale.

Harris said that using the techniques they developed on amphibians, they could develop a similar solution for humans and make it safe for market sale.

Mary Lou Bourne, director of technology transfer and executive director of JMU Innovations, has worked with Harris to help get the research off the ground to a potential developer.

"The fungus could be on any hotel shower floor and usual treatments [for Athlete's foot] are either harmful or ineffective," Bourne said. "This is more effective, less caustic and less costly. Again, this has the potential to be a product."

In 2009, Harris and Minbiole filed for a patent for their research. Harris finally received his patent in August of this year, after spending more than three years developing it.

Minbiole has since left JMU and gone to Villanova University to teach, but his name remains on the patent.

Harris said that a lot of work is still needed before his research can be turned into a marketable product. His main focus remains on his research into the probiotics of amphibians while also searching for a company or startup group to help research and develop the human probiotic research.

"I think a product could be ready to go to market in the next five to 10 years," Harris said. "More and more microbes and bacteria -- bad ones -- are evolving resistances to antibiotics."

Harris said that careful testing of the exact dosage, any side effects and testing on mammals such as rats would be needed before the product would be ready for human trials.

"What we're going through is not atypical," Bourne said. "It takes time to find that right partner. It's a really, really tough process. We have had two that expressed interest but after a while they just seem to stop answering emails."

Another issue Harris and his team have run into with their experiments with amphibians has been the eventual disappearance of good bacteria, leaving the frog susceptible to the infection.

"Not all of the experiments have been successful," Revollar said. "If you add the bacteria into the frog, we analyze it and it sometimes disappears. We're trying to look for ways to keep the concentration in the probiotics constant."

Despite these difficulties, Harris said that he is excited for what this project could develop into.

"It's just the tip of the iceberg," Harris said.

Contact Eric Graves at

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Bunion - Wikipedia, the free encyclopedia

Bunion - Wikipedia, the free encyclopedia
Hallux Abducto ValgusClassification and external resourcesHallux Valgus-Aspect pr? op d?charge.JPGICD-10M20.1ICD-9727.1DiseasesDB5604MedlinePlus001231eMedicineorthoped/467MeSHD006215Hallux valgus.
A hallux abducto valgus deformity, commonly called a bunion, is a deformity characterized by lateral deviation of the great toe, often erroneously described as an enlargement of bone or tissue around the joint at the head of the big toe.

There is disagreement among medical professionals about the cause of bunions; some see them as primarily caused by the long-term use of shoes, particularly tight-fitting shoes with pointed toes,[1] while others believe that the problem stems from genetic factors that are exacerbated by shoe use.[2] Bunions occur when pressure is applied to the side of the big toe (hallux) forcing it inwards towards, and sometimes under or over, the other toes (angulation). As pressure is applied, the tissues surrounding the joint may become swollen and tender. In a survey of people from cultures that do not wear shoes, no cases of bunions were found, lending credence to the hypothesis that bunions are caused by ill-fitting shoes.[3]

The bump itself is partly due to the swollen bursal sac or an osseous (bony) anomaly on the metatarsophalangeal joint. The larger part of the bump is a normal part of the head of the first metatarsal bone that has tilted sideways to stick out at its top.

Contents1 Definition2 Signs and symptoms3 Pathophysiology4 Treatment4.1 Orthotics4.2 Surgery5 See also6 References7 External links

The term "hallux valgus" or "hallux abducto-valgus" are the most commonly used medical terms associated with a bunion anomaly, where "hallux" refers to the great toe, "valgus" refers to the abnormal angulation of the great toe commonly associated with bunion anomalies, and "abductus/-o" refers to the abnormal drifting or inward leaning of the great toe towards the second toe, which is also commonly associated with bunions. It is important to state that "hallux abducto" refers to the motion the great toe moves away from the body's midline. Deformities of the lower extremity are usually named in accordance to the body's midline, or the line bisecting the body longitudinally into two halves. In more severe cases, the hallux continuing in the abductus fashion eventually either overlaps or underlaps subsequent lesser (small) toes especially the second (adjacent toe).

Signs and symptoms[edit]
The symptoms of bunions include irritated skin around the bunion, pain when walking, joint redness and pain, and possible shift of the big toe toward the other toes. Blisters may form more easily around the site of the bunion as well.

Having bunions can also make it more difficult to find shoes that fit properly; bunions may force a person to have to buy a larger size shoe to accommodate the width the bunion creates. When bunion deformity becomes severe enough, the foot can hurt in different places even without the constriction of shoes because it then becomes a mechanical function problem of the forefoot.

Pathophysiology[edit]Illustration depicting a bunion
Bunions are sometimes genetic[dubious - discuss] and consist of certain tendons, ligaments, and supportive structures of the first metatarsal that are positioned differently. This bio-mechanical anomaly may be caused by a variety of conditions intrinsic to the structure of the foot - such as flat feet, excessive flexibility of ligaments, abnormal bone structure, and certain neurological conditions. These factors are often considered genetic. Although some experts are convinced that poor-fitting footwear is the main cause of bunion formation,[4] other sources concede that footwear only exacerbates the problem caused by the original genetic structure.[2]

Bunions are commonly associated with a deviated position of the big toe toward the second toe, and the deviation in the angle between the first and second metatarsal bones of the foot. The small sesamoid bones found beneath the first metatarsal (which help the flexor tendon bend the big toe downwards) may also become deviated over time as the first metatarsal bone drifts away from its normal position. Arthritis of the big toe joint, diminished and/or altered range of motion, and discomfort with pressure applied to the bump or with motion of the joint, may all accompany bunion development. Atop of the first metatarsal head either medially or dorso-medially, there can also arise a bursa that when inflamed (bursitis), can be the most painful aspect of the process.

Bunions may be treated conservatively with changes in shoe gear, different orthotics (accommodative padding and shielding), rest, ice and medications. These sorts of treatments address symptoms more than they correct the actual deformity. Surgery, by an orthopedic surgeon or a podiatric surgeon, may be necessary if discomfort is severe enough or when correction of the deformity is desired.

Orthotics are splints or regulators while conservative measures include various footwear like gelled toe spacers, bunion / toes separators, bunion regulators, bunion splints and bunion cushions. There is a variety of available orthotics (or orthoses) including over-the-counter or off-the-shelf commercial products and as necessary, custom-molded orthotics that are generally prescribed medical devices.

Surgery[edit]A podiatric surgeon performing surgery to remove the bony enlargement and restore normal alignment of the toe joint.
Procedures are designed and chosen to correct a variety of pathologies that may be associated with the bunion. For instance, procedures may address some combination of:
removing the abnormal bony enlargement of the first metatarsal,realigning the first metatarsal bone relative to the adjacent metatarsal bone,straightening the great toe relative to the first metatarsal and adjacent toes,realigning the cartilagenous surfaces of the great toe joint,addressing arthritic changes associated with the great toe joint,repositioning the sesamoid bones beneath the first metatarsal bone,shortening, lengthening, raising, or lowering the first metatarsal bone, andcorrecting any abnormal bowing or misalignment within the great toe.Connecting two parallel long bones side by side by "Syndesmosis Procedure"
At present there are many different bunion surgeries for different effects. The age, health, lifestyle and activity level of the patient may also play a role in the choice of procedure.

Traditional bunion surgery can be performed under local, spinal or general anesthetic. In the case of laser surgery, a narcotic analgesic is typically used.[5] The trend has moved strongly toward using the less invasive local anesthesia over the years. A patient can expect a 6- to 8-week recovery period during which crutches are usually required for aid in mobility. An orthopedic cast is much less common today as newer, more stable procedures and better forms of fixation (stabilizing the bone with screws and other hardware) are used. Hardware may even include absorbable pins that perform their function and are then broken down by the body over the course of months.

See also[edit]FootPodiatryTailor's bunion (bunionette)
References[edit]^ Howell, Phd, Dr Daniel (2010). The Barefoot Book. Hunter House. ^ a b "Bunions (Hallux Abducto Valgus)". 2009-12-18. Retrieved 2011-03-20. ^ SHULMAN, Pod.D,, SAMUEL B. (1949). "Survey in China and India of Feet That Have Never Worn Shoes". The Journal of the National Association of Chiropodists. Retrieved 27 September 2012. ^ "Bunions - Information About Bunion Deformities". 2011-01-24. Retrieved 2011-03-20. ^ Wynn D.P.M., Michael H (October 1986). "Soft-Tissue Bunion Repair with a CO2 Surgical Laser". The Journal of Current Podiatric Medicine 35 (10): 27-28.
External links[edit]Wikimedia Commons has media related to Bunion.Look up bunion in Wiktionary, the free dictionary.Textbook of Hallux Valgus and Forefoot Surgery, complete text online in PDF filesvteMusculoskeletal disorders: Acquired musculoskeletal deformities (M20-M25, M95, 734-738)Upper limbshoulder (Winged scapula, Adhesive capsulitis, Rotator cuff tear, Subacromial bursitis)elbow (Cubitus valgus, Cubitus varus)hand deformity (Wrist drop, Boutonniere deformity, Swan neck deformity)Lower limbhip (Protrusio acetabuli, Coxa valga, Coxa vara)leg (Unequal leg length)patella (Luxating patella, Chondromalacia patellae, Patella baja, Patella alta)foot deformity (Bunion/hallux valgus, Hallux varus, Hallux rigidus, Hammer toe, Foot drop, Flat feet, Club foot)Genu recurvatumHeadCauliflower earGeneral termsValgus deformity/Varus deformityJoint stiffnessLigamentous laxity

anat (h/c, u, t, l)/phys

noco (arth/defr/back/soft)/cong, sysi/epon, injr

proc, drug (M01C, M4)

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