Lengthening the achilles tendon naturally

Hi all i hope somebody can give me some advice as i'm unable to find anything on the net with regard to this problem.

Having suffered with various running injuries for years i stopped altogether and took up cycling instead. Last year i began to read into barefoot running and started out again with a completely different gait. I took it extremely slowly but soon found that i was experiencing ankle pain after a run no matter what the distance.

The pain is located on my right inside ankle just behind the bone. When i started out my ankle would feel 'tight' as i tried to rotate my foot in circles. I kept stretching my calves and the tightness doesn't afflict me anymore however i still get the pain in my ankle. One night in bed i scratched my achilles with my other foot and immediately felt the pain in my ankle. I am convinced this is due to my achilles being compacted as for the last 6 years or so i wore nothing but **** Shox in my spare time and SWAT boots with an air bubble in the heel at work. My heel has therefore been raised about an inch or so off the ground for many years.

Like i said i already made some progress in getting rid of the tightness by stretching so i am fully expecting to be able to rid the pain in the same way. My question is how long this will take? And how much stretching i should do to lengthen my achilles tendon - i don't want to overdo it. I don't know the biology of the achilles tendon - when it is stretched is it slightly damaged and having to rebuild and repair? I've noticed that keeping a hot water bottle on the ankle speeds recovery massively is this due to increased blood flow to the tendon? Should i stretch when the ankle hurts after a run or only when there is no pain? I'm using the stretch where you lower the heel down from a step both with a straight and bent leg - are there any other stretches that might be more appropriate? And if my achilles has been compacted by an approximate inch high heel, will the tendon need to be elongated by a whole inch to achieve pain free barefoot running? How long will this take?

Thanks for any advice in advance - anything more than basic information on tendinitis seems none existant on the web! Essentially, i don't understand what happens when a tendon or muscle is stretched!

This is and interetign question, and one I have myself is how does the physio know whther tightenss is comming from the gastrocs being tight or the achilles tendon being tight is there a way to differentiate: clearly after some injury of some description or pain it's easier ot see, but in the case of tightness how is it possible to know if it it the tight achilles tendon or a tight gasroc pulling on it?

don't know if there is a complete answer to that question. as the muscle and tendon are continuous and integral I don't think any clinical test could pick that up. you can of course differentiate gastrocs vs soleus components as gastrocs is a two joint muscle while sole us is a one joint muscle.

it could also be a bit of an academic point - when a musculotendinous unit is allowed to shorten probably various changes happen simultaneously: the number of sarcomeres in series reduce (muscle only). abnormal production and alignment of collagen fibres throughout the connective tissue (so epimysium, perimysium, fascia and tendon). then ther may also be articular changes at the ankle due to the lack adequate dorsiflexion occurring)

So GCOE if you were treating this guy (scousewil) what woudl you be looking for?
When he says: "on my right inside ankle just behind the bone" are you thinkign that he may have damaged his posterior talofibular ligament? It unlikely without impact that his deltiod ligamants were damaged but I'm not 100% that it is his achilles tendon.
not sure why he felt he had to start "out again with a completely different gait"
I'm wondering if he has overpronated in the past?
Could it be achilles tendon bursitis?
as regards stretchign when there's pain or not, I'd like ot knoe the answer to that myself.
also doe heart always ease burstits, can the same be said for trochanteric bursitis etc. ?
sorry,more questions than answers there!!!

Hi Sarah

First off I am not an expert sports physio. So someone who is may recognise the description as a the presentation from their experience. However to me, the description to date gives me no real clues to what is going on so I am no further forward. So because I am can't use pattern recognition I have to apply clinical reasoning through to the problem just like you and in that way I am no further ahead than you in solving scousewil's riddle.

This is where the futility of a text-based internet discussion is so futile. From what he has said I don't know:

1. the accuracy of his description
2. whether the points he has made are important to solving the problem
3. what actually does matter. The patient has tried to diagnose himself and wants confirmation of his diagnosis. He could be right - but in reality this may just be a red herring. There are HUGE amounts of information missing so I would want to start a fresh.

Pain/symptoms - we know something about the location of the symptoms(althugh the foot is very intricate and a slight error could put us way off the trail) but nothing about the type of pain (could be useful to identifying the tissue type and the pathology) the behaviour of the pain - other than running under two different conditions we don't have a clear description of what makes it worse, the irritatbility and latency of the pain. The pain appears to be variable and therefore heave a mechanical component but is it always there just gets better when he doesn't run? or is intermittant? And what about the 24 hour picture.

We have no objective information. Personally as I have a strong biomechanical base so I would put a lot of weight on observing his running and walking on a treadmill. In my experience a few seconds into watching what he does may give the clue away. I would also look closely at the the posture and muscle function to see what movement impairments if any I can identify - and if he has really had a shortened plantarflexor group then this would show up positive. Then there are the more usual and mundane tests: AROM PROM clinical tests.

I think you can see the point I am making - it is all about a good assessment. Half the time when patients give descriptions on this website you really are no further forward in knowing what is going on (sorry scousewil if you get to read this - no offence meant - just the nature of media really)

so I know I haven't answered any of your direct questions. However can you see why that may just be more red herrings? Before generating anymore hypotheses about what is going on you need to go back to the observing the facts and building up the clinical picture.

Question for you: do you believe at this stage in your development as a physio that you understand WHY you ask each question in the history (eg what does irritability of pain really mean?) and what each test and observation in the objective actually means?

I ask that because that is a real key in improving your diagnositic skills. We often start by rote learning the set points in an examination but until we really know what it means we tend to make a lot of mistakes along the way that we can't correct.