27December 2021
(crashing) – This is Tom Biernacki, and if you have pain in
the back of your heel, this is insertional Achilles tendonitis. And if the back of your heel and Achilles, this hurts, we've got you covered. So skip the surgery. Let's get better at home right now. (light music) So how did you get your
Achilles tendonitis? Tell us what work, how did you get it? Did you trip on something? And subscribe, we love our subscribers. So there's about four common causes of back of the heel pain. One of the most common
is your Achilles tendon. This is the biggest tendon and the strongest muscle in your body. So it inserts into your heel and helps your foot push down.
So what happens is, as
it inserts into the heel, it can rip out of there. With repetitive overload, this could lead to microscopic tears, chronic swelling that could
take a month to get better, even doing all the right stuff. So this can lead to a few things. Over time, this can
lead to a big heel spur at the back of the heel. As it rips out of your heel,
extra bone starts forming, and this starts to become permanent, so don't wait that long. It can also do a couple of other things. There's something called a bursa which is a fluid-filled sac that cushions essentially
the Achilles tendon, there we go. There is something called
a retrocalcaneal bursa which cushions the Achilles
tendon along the heel and between the skin that
stops it from rubbing.
So this can cause shoe rubbing, back of the heel rubbing, lots of problems that can be exacerbated on top of the insertional Achilles tendonitis pain. This is one of, if not the most powerful and the most durable muscles in your body. So the real key is this. Taking a look at this band,
don't let this thing twist every time you take a step, when your foot flattens out,
it twists, then you pull. You wanna have it straight, and then pull. That's what the
biomechanical studies show. If you keep this thing straight, if it's straight up and down, you will have perfect
Achilles tendon function. While you do that, you're not gonna split
those fibers in between, and you will have healing. So the Achilles tendon right
here is straight up and down. Whereas right here, it's twisted out. So it's twisting, then
pushing, as I showed. Right there it's straight in, pushing up. Right there it's twisted out.
So flat-footed people are twisting and then stretching their Achilles tendon. So here's what I'm showing you. It's straight, the fibers are straight, whereas with the flat
foot, it's twisting out. As you come down with a lot of pressure, it doesn't go straight, it twists, then it turns out. That's how all the fibers rip apart. So you don't wanna twist it. You gotta keep it straight. If you keep it straight, so as you see right here,
this is the Achilles tendon, when my foot's straight,
the band is straight. So I can't really show it well there, so don't make fun of me in the comments. As your foot twists out,
the fiber twists out. So here's how you wanna fix it. You want to fix it by, right
now, when I'm barefoot, my foot's twisted out and stretching. In the orthotic it tilts in and keeps it a little bit straighter in just the orthotic alone. Then when you combine
the orthotic with a shoe, this is the best combo right here, combining the orthotic and a shoe.
Look at how much my heel's turned in. There's no flattening
going on in that heel. What you wanna do is, you do
wanna go to your podiatrist. Hey, I'm biased as a podiatrist, but you wanna get it checked out, because sometimes it's not
insertional Achilles tendonitis and sometimes it can be dangerous. So we wanna get an X-ray. An X-ray can show, is
there a stress fracture? Is there a break? Is there a heel spur? Is there something worse
going on like nerve damage? So we can also do an ultrasound to see if there's tears in the Achilles tendon, so it doesn't rip all the way.
And number two, you can then
do an ultrasound or an MRI to see how damaged that tissue is to grade how long it
will take to get better. So Achilles tendonitis
happens due to overuse, too much tightness, and repetitive damage, leading to microscopic tears. So initially it's just
Achilles tendonitis. Then the tendonitis
after three to six months becomes tendinosis. This is thick, non-healing
trauma and damage. And this can lead to a
rupture or years of pain. Sometimes we have patients that have like 10, 20 years of chronic tendinosis that just keeps them on the couch and makes them quit their athletic career. Don't let that be you because you're afraid to go to the doctor.
So there's two ways to limit the pain. You can ice, so 20 minutes at
a time of ice can really help. So 20 minutes, on 20 minutes off, but that's not a true solution, that's just pain control. Just like taking pain medication,
just like taking Tylenol, it lowers the perception
of your body to this pain, but it doesn't help heal
these tired ruptures. But what happens is, anti-inflammatories like
ibuprofen, Aleve, Naproxen, they do lower the swelling
and do lower the inflammation, but it doesn't help heal
these cracks and tears.
Studies have done a great job showing something called menthol-based
creams or Biofreeze, these can work just as well as ice. They basically constrict
the blood vessels, then 20 minutes later open it back up and rush a lot of fluid in there, cleaning out all the inflammatory fluid. So you just put it on and it lasts about 20 to 40 minutes at a time. The next thing you want to do is, you wanna get supportive stuff at home. So, I'm a big fan of great shoes. Look at how firm and supportive that is. Stiff back, stiff bottom, stiff insert with a lot of support. There are stiff supportive slippers. So look at this, this slipper,
it's a little bit old here, but it's got a heel lift and
it's got an orthotic in there. So there's lots of links to
our favorite shoes and slippers down in the links below. But get a good shoe. You want a good shoe for inside the house, a good shoe for outside the house, and you also want an orthotic. So take a look at this. With your Achilles tendon.
It gets stretched when
you land on it like this, but it also, by twisting, so what happens is when
your foot stretches, you stretch and twist at the same time. So what happens is, you
don't want that twist. You want your orthotic to catch it. So see right there how stable it is. It only moves up and down. So see right there, it's not twisting when you land on it, it just goes straight up and down. Whereas watch this, it twists and bends. So the twisting of your
Achilles tendon is really what studies show help cause the ruptures. So an orthotic is key. That's why these work so well.
The problem is people
give up almost right away. They're like, hey, it's not
working in a week or two. It didn't fix my problem. Orthotics suck. The problem is these tears can
take one month, two months, sometimes three, four months to heal up. So you have to be wearing the good shoes inside the house, outside the house, and wearing the orthotics to really get relief
in these chronic cases.
The next thing you wanna do, if the orthotic and the
shoes aren't getting it done, sometimes a brace is needed. So I love stability braces
and compression braces. Taping generally can work well, but this isn't the 1950s anymore. Just spend 20 bucks online. There is links below
to our favorite brace. If the brace didn't do it, sometimes a boot or a cast
needs to be done as well. These can work great. Sometimes surgery is needed. When I first present this,
people think I'm crazy. But if the stretching doesn't
work, if bracing doesn't work, if you're wearing shoes
and like months go by and you're still not better, we bend you to 90 degrees
and get you stretched out to where you need to be with a cast stand and we apply a cast.
For a week or two this holds you stretched in the perfect position. I mean, this is pretty much
guaranteed stretching that, at the same time, heals the fibers. While it is annoying having a cast, hey, this beats surgery in my eyes. And I feel it works
almost every single time, if not every time. In a lot of cases, especially
if there's a heel spur, you want to shave the spur so you get a better attachment. There's two types of surgery. There is Achilles tendon
lengthening surgeries called the gastrocnemius recession, a tendo-Achilles lengthening, or there's even something
called the Baumann procedure which lengthens the calf
all the way up here. I don't have a specific diagram here, but these can work great. The problem is the recovery time is huge and you can do this in the
office by stretching yourself. You don't need it. This is really for
people who can't stretch, who are so arthritic
that they can't do it.
And we do it at the same
time as a bone procedure. If you do have a heel spur
or arthritis, for example, you can detach the Achilles
tendon, shave the heel spur, lengthen the Achilles tendon,
reattach the Achilles tendon, and that works really well. That's when surgery makes
sense, but here's the downside. We're looking at six weeks
in a cast not walking, using a knee scooter,
then six weeks in a boot, and then six more weeks in
a brace and a great shoe, before you're finally in good shape. Plus you still wanna lose some weight, you still wanna cross train. Another thing you wanna do for your Achilles
tendonitis is cross-train. Why just run? Why just play soccer? Or you can go to the gym.
You can work your upper body. You can use a bike and cycle. You can go and swim in the pool. Maybe not during COVID, but
yes, you can do these things. Cross-training can really
help you get better. The problem with the stretching is it just stops it from rubbing. It doesn't heal the ruptures
and the microscopic tears. The way you want to do
this is, you wanna massage and you wanna stretch your Achilles tendon to stop it from rubbing as much. There's a few ways to do that. Here's what studies show. This is a very misunderstood
treatment modality, but here's what the
massage roller stick does. You take the massage roller stick and you massage your calf
muscle, your thigh muscle, for only 30 to 60 seconds.
What's the benefit of this? It doesn't do anything as far
as strength, getting stronger, nothing along those lines. The only one thing that this does is makes you more flexible
for the next hour or two. These are what the studies show. So here's what you do with this. 30 to 60 seconds on the front of your leg. This is the muscles, not the shinbone, that would hurt. 30 to 60 seconds, oh, I
can feel that getting deep. That's way better than that ball. Same thing with the plantar fascia. Look at this, that feels
a million times better.
You can do this on your thigh
real quick, 30 to 60 seconds. Ham strength, 30 to 60 seconds. Here's what the benefit of massage does. For the next hour or two you can stretch further, run better. That's what's recommended
with the massage stick. Massage all these out, get
rid of this inflammation. And then for the next hour or two you can stretch that
hamstring, that thigh muscle. As we mentioned, the key is to massage. The foam roller is great
for your midsection, so for your glutes, for your hip flexors, for your groin.
This is fantastic for your hamstring even. Get that inflammatory fluid out of there. Use 30 seconds to
massage out your muscles, your calf muscle, that's
above your Achilles tendon. Loosen that up, take that
stress off your Achilles tendon. Get that inflammatory fluid out of there. Massaging and protection is
the key at the beginning, and stretch out that plantar fascia. So all the bottom of your
foot, your ligaments, your tendons, get that fluid out of there, especially in the morning
when you're sore and stiff. That lets you take a
first step without pain, and then rotate your ankle. Loosen up that Achilles right there, loosen up those ankles
and get them symmetrical. And then gently stretch it, never painful. If the stretch is painful, so if your calf, if your
hamstring are painful, you're doing more harm than good. It should be a gentle
massage and a gentle stretch. And you should feel loose afterwards so that your plantar fascia, that can take pressure
off your Achilles tendon. Loosen that up. I love to put the towel so
that you raise your feet, because to stretch out your
calf muscle and your ankle you wanna get 10 degrees past 90.
So boost up your feet, stretch those out, stretch out your hips,
the inside of your thighs. That's your groin region. That lets your hips rotate
and externally rotate out. This thing, it's a half moon stretcher. Realistically, I don't
like doing it barefoot. You're gonna hurt the back of your heel, but gently you're gonna be stretching out your Achilles tendon. If you have 50 bucks, this stretcher will
stretch both of your feet. In my opinion, time's more important than a couple of bucks, specifically like $20 versus $50. Stretch both at the same time. Look at that. You can increase the angle. While you're drinking your coffee or brushing your teeth in the morning, or getting ready or checking
your emails on your phone, you could be stretching
out both your feet, your hamstrings, your hips,
with this stretching device. So, to stretch out your hamstrings we have this hamstring stretching device. I think this one's like
$55, down in the show notes. And everything's linked
down in the show notes. This can stretch out
specifically your knee. If you have a tight knee. So sometimes people after a knee surgery, you can stretch out your
knee using this method.
Look, it also pushes on your feet. But realistically, if you have a towel, what I showed you earlier,
that's the cheaper route to go. It's probably even easier
just to use gravity and not your arms. If you get a shoe and the
orthotic, as we mentioned, it holds your heel turned in, and your big toe dropped. That stretches out your
calf, your hamstring, your knee, without
tilting your foot outward. See how that holds your
foot straight up there. That's really the way to go. That's how you're gonna get your foot feeling a whole lot better. That's gonna do much, much better overall. Stretch both feet at the same time, hamstrings, glutes, calf muscles. It's gonna take all that stress
off your Achilles tendon. A few different stretching devices, I love the ankle slant board the most. That's probably by far the best one. (light music).