With summertime just around the corner, we are starting to see a lot more Achilles problems, injuries and overuse injuries. We see a number of Achilles tendon ruptures, and fortunately this is not that common. The most common condition we see is calcific changes of the Achilles tendon. There can be problems for within the tendon itself in the middle of the tendon up above the heel bone (watershed region) but very often it occurs at the insertion of the Achilles tendon, at the posterior aspect of the calcaneus. When there is inflammation at the insertion of the Achilles tendon over time this inflammation can lead to degenerative changes and calcific changes within the tendon itself (Calcific Achilles tendinosis, sometimes referred to as Achilles tendinitis). Over time this can progress to bone formation and when you look on x-ray see a large spur. X-rays can be helpful if it's a fairly large spur or area of calcific changes. But my favorite diagnostic evaluation technique is ultrasound imaging. With ultrasound imaging even very small areas of calcific changes show very clearly at the insertion of the Achilles tendon. There are a number of treatment options for this if it's caught before the spurs too large.

• The #1 treatment for this is prescription orthotics to control the side to side motion of the foot that would otherwise cause mechanical shearing at the insertion of the Achilles tendon.
• A special brace for Achilles problems called an Achillotrain brace.
• Eccentric Achilles strengthening exercises are also very helpful.
• EPAT–extracorporal pulse activation technology also known as shockwave therapy. This is the newest treatment that we offer at our clinic. The shockwave therapy is typically done once a week for 3 treatments. For more severe cases it is 5 treatments over a 5 week course. The maximum improvement often occurs between 12 and 16 weeks post initiation of treatment. This is a great treatment because there is no down time and no injection required. If you would like to know more about shockwave treatment for Achilles tendinitis or have other questions regarding this type of heel pain or Achilles problems please let us know. Both Dr. Brandon Nelson and myself, Dr. Timothy Young treat a lot of these sports type Achilles problems.