Alexandra K. Grulke, DPM, FACFAS, CWS
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Trained in all aspects of podiatry, with special focus in pediatrics and foot/ankle reconstructive surgery

David Ortiz Makes Progress with Heel Pain

Not good news for the struggling Phillies. The Red Sox First Baseman David Ortiz, who in yesterdays game was 2 for 4 with 1 run scored, has been able to successfully manage his right heel pain that has plagued him most of the season. David Ortiz has been suffering with Achilles tendinopathy for quite awahile but following his doctor's order he has been able to have play at a high level which includes his performance against the Phillies last night.

Achilles tendinopathy is pain at the back of the heel, not the bottom of the heel such as plantar fascitiis. The Achilles tendon, which is made up of 2 separate muscles, attaches the back of the heel bone. The Achilles tendon is the largest tendon in the body. The tendon helps the foot bend down such as when you push off the walk, run or jump. The tendon is very powerful but can be subjected to overuse and degeneration such as in Achilles tendonitis or tendonopathy. So how does this develop?

Achilles tendinopathy can occur from an number of reasons. The most common reason is tight calf muscles. These tight muscles will put a strain on the Achilles tendon where it attaches to the heel bone. Also, a sudden start of activity or and increase in the intensity of an activity can cause strain on the muscle or tendon. In addition, a heel spur can develop at the attachment of the tendon at the heel bone. When the tendon pulls on the heel bone the response of the bone is to form bone in the direction of the pull, this can result in a heel spur.

Common symptoms of Achilles tendinitis include:

  • Pain and stiffness along the Achilles tendon in the morning
  • Pain along the tendon or back of the heel that worsens with activity
  • Severe pain the day after exercising
  • Thickening of the tendon
  • Bone spur (insertional tendinitis)
  • Swelling that is present all the time and gets worse throughout the day with activity

After a thorough evaluation by your podiatrist, a number of conservative, non surgical treatments will be initiated. Rest, switching to lower impact activities and stopping the activity that causes pain, Ice, 20 mins on and 20 mins off at the end of the day placed on the back of the heel and Elevation, to reduce swelling, are the usual first steps in the treatment of Achilles tendonitis. NSAIDs can be used to help with inflammation and pain relief. Heel lifts to lift the heel off the ground to put less tension on the achilles can be used in the short term for treatment. Stretches can be used to treat tight calf muscles such as the wall push up,

use a band to stretch

or even the stairs

or if even formalized physical therapy.

Achilles tendonitis or tendinopathy can be managed or even cured with the right treatments as prescribed by your podiatrist. Let's hope the Cliff Lee will have an answer tonight against David Ortiz tonight. Go Phils!

Dr. Alexandra "Sandie" Grulke

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