Achilles tendinitis in a 11 years old soccer player

Patient

Q: Hello.My 11 yr old son has been playing a lot of soccer in the past 2 weeks (barefoot and with cleats on) and is complaining about aching ankles (top of ankles - around talus area).He says it aches less when he points his feet straight.Prior to last 2 weeks he was on Summer break here in new Zealand so was not playing much sport.I used to suffer same aching at start of each soccer season. Is this just overuse after not playing for some time? Would strengthening exercises be recommended ? He also started wearing orthotics last year to correct pronation in both feet.Thanks.

Doctor

A:    Achilles tendinitis is an acute inflammation of the heel tendon, usually resulting from overuse associated with a change in playing surface, footwear, extreme stretching or intensity of an activity. When the calf muscles contract, the Achilles tendon is tightened, pulling the heel. This allows pointing your foot and standing on tiptoe. The treatment must emphasize: Protection and allow the necessary time to healing and to prevent re injury. Moving the foot and ankle is needed to prevent stiffness and loss of muscle tone. The self-care includes the PRICE acronym: protection, rest, ice, compression and elevation. Anti inflammatory medication (“Advil”, “Motrin”) may be used to control pain and inflammation. Appropriate stretching and exercises help the healing process: Stretch with knees straight, with knees bent and exercise the calf muscles. An regarding the orthotic devices: these may protect or correct the position of foot and ankle to promote healing, then a shoe wedge that slightly elevates the heel may relieve the strain on the tendon and give a cushion , reducing the amount of force over the tendon. It is very important allow enough time to heal, increase the level of activity gradually, if pain is notice during a particular activity: stop and rest; use the appropriate footwear, stretch daily(Achilles and Calf muscles), alternate high impact activities (running, jumping) with low impact activities (swimming, cycling).

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