Chronic Foot Problems and the Achilles Tendon

Ross Hauser, MDRoss Hauser, MD

As we age, flat feet become more common. This means that the foot has too much pronation (turning outward). As the foot pronates excessively, a Plantar Fasciitis or even a Heel Spur can occur. To prevent these injuries from occurring, proper footwear is essential to support the arch through correct orthotics. Once plantar fasciitis occurs, Prolotherapy of the plantar fascia (strong attachments at the bottom of the foot) can be quite helpful in eliminating this pain.

This type of injury generally comes on gradually and presents itself as discomfort noticed at the front of the heel or arch when one first gets out of bed in the morning. Pain exacerbates significantly with any increase in athletic activity. When the athlete is off of his/her feet for any period of time, the injured fascia begins to feel better. Unfortunately, the healing bond is quite weak so that when walking without arch support or exercising, the plantar fascia begins to tear. This results in pain in the area where the plantar fascia attaches to the calcaneous (heel bone), and a formation of a bone spur. Bone spurs tell the athlete and physician that there is weakened and injured tissue present, which is generally a ligament. Use of an arch support helps to prevent the plantar fasciitis from recurring, but Prolotherapy is needed to strengthen the healing bond.

In addition to the Prolotherapy, proper stretching of the muscles of the lower leg is also helpful. Correction of this problem will also involve evaluation of the gait in order to determine if there are other factors that may be perpetuating this problem, such as other ligament weakness, skeletal malalignments, or muscular imbalances. However, the most important factor in curing sports injuries is to stimulate the regeneration of the injured tissue by Prolotherapy.

The Achilles Tendon: The Weak Link for Many Athletes

The Achilles tendon is the largest tendon of the human body and is one of the most commonly injured tendons in sports. It is the tendon responsible for plantar flexing of the foot, which is how athletes are able to spring off of each step.

Athletes in running sports have a high incidence of Achilles tendon overuse injuries. About 75 percent of total and the majority of partial tendon ruptures are related to sports activities involving abrupt repetitive jumping and sprinting movements.

Surgery is supposedly required in about 25 percent of athletes with Achilles tendon overuse injuries, and the frequency of surgery increases with patient age and duration of symptoms, as well as occurrence of tendinopathic changes.

Of those who receive surgery, 20 percent require reoperation. These are sad statistics if one knows the pathology in chronic Achilles problems. The condition begins as a tendonitis because the Achilles tendon is trying to strengthen. But often, because of NSAIDs and cortisone, the inflammatory process is halted. The tendon then begins to show signs of cellular damage and collagen degeneration. This is called tendinosis. Tendon pathology such as this can only be encouraged to repair itself with Prolotherapy. Only Prolotherapy will be able to stimulate the growth of the Achilles tendon tissue to make it stronger.

Steroid injections not only do not help the problem, they likely cause the problem. Steroid shots with cortisone have been implicated as a significant cause of Achilles tendon rupture.