Patient: Good morning, I am 40 and play basketball. A couple of months ago my achiles on both legs started hurting really bad. I wake up and they are stiff and sore. They loosen up a bit during the day, but if I run they hurt really bad. I have heard this is Achilles Tendenitis. Both Achilles hurt to the touch a bit as well. Please let me know how to treat this.
Doctor: HelloThanks for posting your query.The pain in the region of tendo achilles can be commonly due toRetrocalcaneal bursitisTendo achilles tendinitisPartial rupture Tendo achilles (less common diagnosis)When does your pain aggravate- when your ankle is bent upward (dorsiflex) or when you rise on your toes or both of them?Is the back of heel red and swollen?Both of these conditions follow similar line of treatment.1. Avoid activities that aggravate the pain.2.Take OTC available nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen to decrease inflammation and pain.3. Apply ice packs over the heel several times a day.(In case the heel area is red amd swollen)4. Use OTC available or custom heel wedges in your shoe to raise the heel and decrease the strain over the tendo achilles by passive plantarflexion.5. Focal ultrasound treatment is helpful in both the conditions.In case of no relief with these measure, treatment guidelines for the two differIn case of retrocalcaneal bursitis- local steroid application (injection) is given by a orthopaedic specialist only. If still there is no relief then excision of the bursa is advised.In case of tendo achilles tendinitis- ankle is immobilized in plantarflexion to relax the gastrosoleus muscle and decrease the pull over the tendo achilles insertion on the calcaneum, thus bringing pain relief. Ankle immobilisation is done either by external splint or a cast.If there are any more doubts, please feel free to discuss.Regards