Debbie is a triathlete who came to see me with pain in her Achilles, above the heel below the calf. She had been suffering with this issue on and off for around nine years and it had flared up again recently and getting worse over the last six months. Predictably, the injury is aggravated by running and relieved with rest.
Debbie – Achilles pain
Tests
After a postural examination to compare her pelvis, knee and leg alignment I then looked at the offending ankles. Comparing the movement of passive and active movements in both ankles helped to compare their performance. An anterior and posterior draw test also checked the stability of the ankle. Finally, a syndesmosis test, squeezing the tibia and fibula together, tests the ligaments in the ankle.
Diagnosis
These tests helped to diagnose ligament damage, often referred to as high ankle sprain. I discounted the more common Achilles tendonopathy with palpation and a Thompson’s test, which left me in no doubt where the problem lay. The thickening of the tendon was due to wear and tear and hyper extension of the ankle and knee joints.
Treatment
In cases like these it is important to treat the whole limb in order to address the root cause of the problem. Soft tissue and myofascial massage released tension in the muscles and surrounding structures and then I applied muscle energy techniques which promoted lymphatic drainage. Finally, after testing Debbie’s reflexes, some tendon release work helped to ease tension in the tendons of the leg, knee and ankle areas. These treatments significantly reduced the pain Debbie was feeling, but in order to avoid recurrence it was important for her to address the imbalances which were causing the condition. I recommended a new orthotic insole prescription, as the orthotics she was currently wearing were several years old.
Results
With such a long standing injury it is likely that Debbie will require ongoing sessions in the future to relieve any new incidences of pain in this area. However, with the right orthotics and podiatry advice, we should be able to manage the condition enough to enable Debbie to continue training and competing.
