The achilles tendon is very often our achilles heel. Some of our patients aren’t experiencing pain in the back of their heel or achilles tendon. Some may never experience pain in the back of the heel or achilles tendon. However, having a tight achilles tendon causes a variety of compensation leading to foot pain. It creates a change in the distribution of our body weight as well, which can lead to overuse injuries. Some would claim that especially for athletes, having a certain amount of tightness in the achilles tendon helps to improve performance, but at some point this will come at a price.
Equinus is the term used to describe having a tight achilles tendon. This comes from a word referring to horses, as they essentially walk on their toes. There are two main ways that this tightness occurs in humans. To understand, you have to know that the achilles tendon is made up from two different muscles. The gastrocnemius is the muscle that starts on the femur (thigh bone) above the knee. The soleus muscle lies deep to the gastrocnemius and originates within the leg – so lower than the gastrocnemius muscle.
The importance of understanding the anatomy is due to the fact that there are a few positions are effective in stretching the achilles tendon. If a person has gastrocnemius equinus, it means that the tightness is from the muscle coming from above the knee, so we must stretch this muscle with the knee straightened. If both muscles are tight, we will then add in a stretch that allows a slight bend in the knee to target the soleus muscle as well.
There are a variety of stretches you can do actively to loosen up these muscles. In some cases, stretching on our own does have some limitations. It may be due to your comfort level or even your overall mobility and agility or balance. Alternative ways to loosen up tight legs/ankles include physical therapy and something we call a stretching splint.
When you are in charge of your own stretching destiny at home, you may get busy and forget. You may also have an occupation or lifestyle that plays into the tightness you have, making this an uphill battle. Physical therapy allow some consistency in your treatment of your foot and ankle condition, but there are also techniques used to reduce tightness in ways you cannot achieve at home. Deep tissue massage, fascia therapy, dry needling and even having your therapist passively stretch you are all incredibly helpful. But even when you have physical therapy, at most you may have 3 visits per week. That is only 3 times in 7 days that you are devoted to stretching and improving your flexibility and function.
This is why a stretching splint is so helpful. A stretching splint, when applied correctly and worn consistently, gives you the freedom to further improve your mobility in the comfort of your own home. There are a variety of styles available and the one that we carry at our office has been found (by both our physicians and our patients) to be the most comfortable and effective. It is designed with cushion between the splint and the hard shell. The hard shell helps improve the durability of the product. There are adjustable straps in order to allow you to slowly increase the stretch you receive when wearing the device. In addition, there is a toe strap that adds even further gentle pull on the plantar fascia band if you are suffering from plantar fasciitis.
So, what other conditions can benefit from a stretching splint? Well as I said earlier, a tight achilles tendon creates a whole lot of changes in our feet that can lead to a variety of foot ailments. The two most obvious places where a stretching splint is appropriate is for plantar fasciitis and achilles tendinitis. By using a stretching splint at these times, reduces our compensation and loosens these structures which have progressively become tight and eventually became inflamed and painful. The stretching splint is one of the first line treatments in both of these cases.
Another condition where stretching splints are helpful is calcaneal apophysitis. This condition, also referred to as Sever’s Disease by some, is seen in pediatric patients. This is when a tight achilles tendon causes excess pull on the growth plate in the back of the heel. This condition is seen in kids around age 10-12 when the growth plates are preparing to close in this area. Commonly, our patients who experience calcaneal apophysitis have flare ups in the springtime. This happens especially with soccer and other sports played on the ground that is harder in the early spring months. An ankle brace is helpful in this condition, but stretching splints are later useful to reduce the pull of the achilles tendon and improve function in the feet.
Ball of foot pain can many times be associated with having equinus. By the heel cord (achilles) pulling up on the back of the foot, your weight may be transitioned toward the ball of the foot more and overloading this area can cause a few different conditions. One of these conditions is called a neuroma, which is a scarred nerve in the ball of the foot which causes a feeling that there is something/a ball in the foot when walking barefoot. These patients will also experience radiating pain into the toes often times.
Another cause of pain in the ball of the foot is a stress fracture. The same forces in the foot from equinus can cause compromise within the bones in the ball of the foot and creates hairline fractures. These hairline fractures can break through completely if not treated. A stretching splint is not the first line treatment for these stress fractures, as initially we need to allow the injured bone to recovery. However, once a stress fracture has healed, a stretching splint (as well as custom orthotics) can help to reduce the likelihood of recurrent stress fractures.
Simple, regularly performed stretching is very important in an active lifestyle. If you make this part of your routine, any small amount of equinus you have may not lead to pain in your feet. It may not lead to injury. However, once we are so tight that pain and inflammation result, you’ll need a more heavy dose of stretching. The stretching splint is very convenient and incredibly helpful for this. If you are having foot pain and you are wondering if a stretching splint is right for your, please make an appointment for evaluation today!