Achilles tendon injuries are a very common among athletes of all ages. Young athletes will commonly report pain, stiffness, and perhaps difficulty running or cutting during competition, which are symptoms of Achilles tendinitis. Continued aggravation leads to difficulty with walking and even pain at rest. Once to this stage, athletic competition is reduced or eliminated until symptoms resolve.
Prevention
The best treatment of Achiles tendon injuries, of course, is prevention.
As with most rehabilitation treatments and recommendations, the methods used in treating injuries are the similar to preventing them. Any serious injury or ongoing problem should be evaluated by your physician, physical therapist, or athletic trainer to determine the extent of injury and proper course of treatment.
To reduce risk of injury while increasing the strength, power, and dynamic capabilities of the foot and ankle:
1. Correct for excessive flat feet or high arches
Overly flat or arched feet are a factor of Achilles tendon injuries but should not be the only prevention/treatment modality. Symmetrical feet that are somewhat flat or arched do not usually justify purchase of $500 orthotics. That being said, an athlete with very pancake feet or arches high enough to roll a tennis ball underneath will benefit from a preventative orthotic. Also, a history of heel pain is certainly a reason to investigate further to determine if an orthotic is appropriate for your child.
2. Stretch tight calves
Stretching is important to injury prevention in all sports, particularly if the individual's muscles are very tight. Calf muscles that are consistently tight can stretch across the Achilles tendon, increasing the risk of irritation.
A simple stretching program to stretch the gastrocs and soleus muscles, often performed against a wall with the back knee straight or bend, respectively, is great. This, like the orthotics, is a factor for injury risk and should not be overdone. Stretching the calves 10 times a day in the belief that it will eliminate all problems is misguided. A little every day is the best approach.
3. Eccentric calf raises
This technique involves an athlete standing on the edge of a step, box, or other elevated platform. The athlete lifts both heels off the ground as high as possible, then lowers the body with one leg in a slow and controlled manner. The purpose of this exercise is to improve eccentric strength (actively controlling the lengthening of a muscle), which translates into stronger and more resilient tendons.
In physical therapy, this is the gold standard to treat Achilles tendonitis. Completing 2-3 sets of 10-15 reps 3-4 times a week is more than sufficient to reduce overall risk of injury. Push to fatigue but never through pain.
4. Avoid heel lifts
There has been debate on the effectiveness of heel lifts for Achilles tendon pain and prevention of injury, but a meta analysis of various therapy treatments revealed that the technique is counterproductive. Adding a heel lift does reduce the tension across the heel but does not sufficiently address the problem. Avoid putting heel lifts into your young athlete's shoes as a means to prevent Achilles tendon injuries or address pain, as the benefits are temporary and will not solve the underlying issue.
5. Pay attention to warning signs
This is the most important thing a parent can do to reduce risk of injury. Achilles tendon injuries are usually the result of chronic irritation, meaning they develop over weeks and months, not in days and hours. If any symptoms begin to appear, following the recommendations set out above may ward off more serious problems.
Remember: a reduced volume of activity and simple interventions can make most chronic injuries easily avoided! As always, if there is considerable doubt in your head or your "gut" feeling says there is something seriously wrong, please consult a healthcare professional. While Achilles tendonitis is not a life threatening injury, prolonged irritation without proper assessment can mean a child being sidelined for weeks or months.
Keith Cronin is a physical therapist in the St. Louis area and a MomsTeam expert.
Source: Carcia, C., Martin, R., Houck, J., and Wukich, D. Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis - Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association. J of Orth Sports Phys Therapy. 2010:40(9):A1-A26.
Posted April 7, 2011, revised January 4, 2012
