Heel pain is one of those issues that can affect most of what you do in a day and can be disabling. A common cause of heel pain is the Achilles tendon. What is the Achilles tendon? What is Achilles tendonitis? What are the different injuries? Are injections of bone marrow concentrate (BMC) for Achilles tendonitis a viable option? Let’s dig in.
Where & What Is the Achilles Tendon?
A tendon is a thick fibrous band of connective tissue that connects a muscle to bone. There are more than 30 million tendon and ligament injuries annually (1). The Achilles tendon, which is the thickest tendon in the body connects the calf muscles to the heel bone (2). It consists of the gastrocnemius and soleus muscles that unite to form a thick band that is immediately above the heel tab on your shoe. It enables the downward movement of the foot and bending of the knee.
Symptoms of Achilles Tendonitis
Achilles tendonitis symptoms include pain and swelling in the Achilles tendon. The tendon may also feel stiff and be difficult to move.
Achilles Tendon Pain
The Achilles tendon, the thickest and strongest tendon in the body, originates from the calf muscles ( gastrocnemius, soleus, and plantaris) and inserts upon heel bone (calcaneus). Achilles tendonitis, an inflammation of the tendon, is painful and can be difficult to treat. Conservative therapy includes trials of NSAIDs, orthotics, and physical therapy. Physical examination was significant for weakness in the left big toe and abnormal neurologic exam consistent with nerve root irritation of a lumbar nerve root. After being tapering off his cholesterol medication, RC underwent myofascial deactivation(IMS), x-ray guided injections of platelet-derived growth factors into the lumbar spine, ultrasound-guided injections of PRP, and physical therapy.
More than any other joint, our ankles bear the burden of all of our body weight. The ankles aren’t large weight-bearing joints, like our hips or knees; comparatively speaking, the ankles are rather small for the tasks they are assigned to do. If the ankles are normal and healthy and there isn’t a weight issue placing excess stress on the ankles, the ankles can typically bear the forces of walking, running, hiking, and so on quite well. However, when the ankles are weak or carrying too much weight, any additional forces placed upon them—even something as simple as walking—can create problems.
Do your ankles get sore after walking? What about foot and ankle pain after hiking? If so, it’s a good idea to proactively address it now, before it gets worse, rather than resigning yourself to it and decreasing or stopping the activities you enjoy.
We’ll explain more in a moment, but first let’s take a closer look at the structure of the ankle.
There are multiple causes of ankle pain while running. The six major causes are: Stress Fracture
A stress fracture is a small crack in the bone due to overuse and repeated impact. They are a common cause of pain in runners, accounting for up to 16% of injuries. The shin bone (tibia) is the most commonly affected bone accounting for approximately 40 % of stress fractures. Pain is the most common symptom. Plantar Fasciitis. The plantar fascia is the thick connective tissue that extends from your heel to your toes. Plantar fasciitis is the inflammation of the plantar fascia and is the most…
We often see patients with outside ankle pain who have no idea how it happened; they just know their ankle suddenly started hurting. One patient was a classic example of this. As an athletic hockey and Lacrosse player, however, it’s highly possible he experienced sprains and other ankle injuries, even minor ones, over the years, and these, rather than one big traumatic episode, could have been the catalyst to his sudden outside ankle pain. Outside ankle pain can be treated without surgery by an interventional orthopedics physician. Loose or torn ligaments usually can be treated nonsurgically with ultrasound-guided high-dose platelet-rich plasma (PRP) injections…
Heel pain can be intense and, despite rest and trying a variety of other conservative measures, it can often also be persistent.
Every year, there are over a million visits to primary physicians for plantar heel pain. Plantar heel pain affects both men and women equally, and there are many causes of plantar heel pain.
Therefore, it is important to diagnose the cause of the heel pain so that it can be treated appropriately. We will review the causes, complications, and treatment options for plantar heel pain.
Injury to the Achilles tendon is common and can be a significant source of pain and dysfunction. There are three principles injuries to the Achilles tendon
Inflammation
Inflammation of the Achilles tendon is called Achilles tendinitis. The most common symptom is pain and swelling of the tendon (3). Onset can occur due to overuse but has also been associated with high heel shoes, steroids, and fluoroquinolone class antibiotics (3). Ciprofloxacin and Levaquin are examples of this class of antibiotics.
Degeneration
If left untreated, the Achilles tendon inflammation can progress to degeneration of the tendon. This is called tendinosis. It can occur with tears in the tendon. Pain, swelling and impaired function are common. It may affect 9% of recreational runners and cause up to 5% of professional athletes to end their careers (4)
Rupture
Tendon rupture occurs when the tendon pulls off the bone to which it is attached or when the tendon breaks apart. The rupture may involve all or just a portion of the tendon. It results in the creation of two tendon ends that are physically apart. Rupture can occur with long-standing Achilles degeneration, direct trauma or abrupt bending of the foot (5). It is most common in cyclists, runners, and volleyball players. Most Achilles tendon ruptures occur in young males between 20-39 years old (6). Surgery is required with full Achilles tendon ruptures.
Does BMC Work for Achilles Tendonitis?
Yes! BMC Achilles tendon treatment is a viable treatment option Tendons can be difficult to heal because they have poor blood flow. Without blood, an injured or damaged tendon has a difficult time healing. Bone marrow concentrate is rich in a number of cells including stem cells. Clinical and laboratory studies have both demonstrated that bone marrow concentrate can accelerate and improve the quality of tendon healing by reducing inflammation and improving collagen production (7, 8). Inflammation is one of the central problems in tendonitis.
The tendon tear involves only a portion of the tendon.
Full-thickness Tear
The tendon tear involves the entire tendon but the tendon fibers remain intact and have not separated.
Full-Thickness Tear with Retractions
The tear involves the entire tendon and the tendon is torn away from the bone or snapped into two pieces. Partial-thickness and full-thickness tendon tears can be treated with BMC whereas full-thickness tears with retractions require surgery. PRP is platelet-rich plasma that is rich in growth factors that can accelerate healing. Bone marrow concentrate, when combined with PRP, has been effective in healing tendon tears, decreasing pain, and increasing function (9). Hernigou has clearly demonstrated that bone marrow concentrate can significantly improve tendon healing (10). At the Centeno-Schultz Clinic, we have seen an extensive amount of Achilles tendon injuries, and our most recent publication demonstrated that contrary to conventional wisdom, a higher concentration of PRP is better for tendon repair than lower concentrations (11). This is critical as a higher concentration of PRP is only available in clinical practices like the Centeno-Schultz Clinic which have a state-of-the-art PRP and BMC laboratory. To better understand why for the best clinical outcome a flexible, state of the art laboratory is essential please click on the video below
Prolotherapy Injections
It has been successful in the treatment of many disorders including neck, shoulder, knee, and ankle pain. Dr. Centeno recently published an article in The Journal of Prolotherapy in which he discusses the use of x-ray guidance with prolotherapy. This ensures that the injection is in the correct place to maximize clinical results. Dr. Centeno discusses the use of prolotherapy for the treatment of neck, knee, sacroiliac joint, ankle, ischial tuberosity, and shoulder pain. At the Centeno-Schultz Clinic x-ray guided prolotherapy is just one of the therapies utilized in the successful treatment of pain. Regenerative injection therapy (RIT) or prolotherapy…
PRP is short for platelet-rich plasma, and it is autologous blood with concentrations of platelets above baseline values. The potential benefit of platelet-rich plasma has received considerable interest due to the appeal of a simple, safe, and minimally invasive method of applying growth factors. PRP treatments are a form of regenerative medicine that utilizes the blood healing factors to help the body repair itself by means of injecting PRP into the damaged tissue. In regenerative orthopedics, it is typically used for the treatment of muscle strains, tears, ligament and tendon tears, minor arthritis, and joint instability. There have been more than 30 randomized controlled trials of PRP…
Very little can feel more debilitating to your normal way of life than severe ankle pain. When you aren’t able to get around on foot without moderate to excruciating pain, there is a whole world out there that can feel inaccessible or off-limits. Many times, when patients are encumbered with severe or unbearable ankle pain, physicians are quick to recommend ankle fusion surgery as a remedy.
The Tenex Health TX® System is a minimally-invasive, percutaneous procedure using ultrasonic energy to treat pain-generating soft and hard tissue conditions. This treatment is clinically proven to remove tendon pain for over 85% of patients1,2,3,4,5. If conservative approaches such as physical therapy, cortisone injections, medication, and downtime do not provide relief, Tenex may be your next option.Using this technique, we help patients restore musculoskeletal function, may provide quick pain relief, and avoid invasive surgery and dangerous drugs. Tenex may also be effective if you have had a failed surgical procedure. Your doctor will use image-guidance to identify and target the…
A tendon is a thick band of connective tissue that connects a muscle to bone. The Achilles tendon connects the calf muscles to the heel, and is susceptible to injury. Injuries to the tendon include inflammation, degeneration, and rupture. Pain, swelling, and restricted movement are common. Tendons have poor blood flow and therefore are difficult to heal. However, with your own bone marrow concentrated and injected precisely with image guidance, the body has shown to repair itself.
Our Doctors Who Treat Achilles Tendonitis
Christopher J. Centeno, MD
Christopher J. Centeno, M.D. is an international expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate in orthopedics. He is board-certified in physical medicine and rehabilitation with a subspecialty of pain medicine through The American Board of Physical Medicine and Rehabilitation. Dr. Centeno is one of the few physicians in the world with extensive experience in the culture expansion of and clinical use of adult bone marrow concentrate to treat orthopedic injuries. His clinic incorporates a variety of revolutionary pain management techniques to bring its broad patient base relief and results. Dr. Centeno treats patients from all over the US who…
John R. Schultz M.D. is a national expert and specialist in Interventional Orthopedics and the clinical use of bone marrow concentrate for orthopedic injuries. He is board certified in Anesthesiology and Pain Medicine and underwent fellowship training in both. Dr. Schultz has extensive experience with same day as well as culture expanded bone marrow concentrate and sees patients at the CSC Broomfield, Colorado Clinic, as well the Regenexx Clinic in Grand Cayman. Dr. Schultz emphasis is on the evaluation and treatment of thoracic and cervical disc, facet, nerve, and ligament injuries including the non-surgical treatment of Craniocervical instability (CCI). Dr. Schultz trained at George Washington School of…
Dr. Pitts is originally from Chicago, IL but is a medical graduate of Vanderbilt School of Medicine in Nashville, TN. After Vanderbilt, he completed a residency in Physical Medicine and Rehabilitation (PM&R) at Emory University in Atlanta, GA. The focus of PM&R is the restoration of function and quality of life. In residency, he gained much experience in musculoskeletal medicine, rehabilitation, spine, and sports medicine along with some regenerative medicine. He also gained significant experience in fluoroscopically guided spinal procedures and peripheral injections. However, Dr. Pitts wanted to broaden his skills and treatment options beyond the current typical standards of care.
Post-residency, Dr. Markle was selected to the Interventional Orthopedic Fellowship program at the Centeno-Schultz Clinic. During his fellowship, he gained significant experience in the new field of Interventional Orthopedics and regenerative medicine, honing his skills in advanced injection techniques into the spine and joints treating patients with autologous, bone marrow concentrate and platelet solutions. Dr. Markle then accepted a full-time attending physician position at the Centeno-Schultz Clinic, where he both treats patients and trains Interventional Orthopedics fellows. Dr. Markle is an active member of the Interventional Orthopedic Foundation and serves as a course instructor, where he trains physicians from around the world.
Dr. Money is an Indiana native who now proudly calls Colorado home. He attended medical school at Kansas City University and then returned to Indiana to complete a Physical Medicine and Rehabilitation residency program at Indiana University, where he was trained on non-surgical methods to improve health and function as well as rehabilitative care following trauma, stroke, spinal cord injury, brain injury, etc. Dr. Money has been following the ideology behind Centeno-Schultz Clinic and Regenexx since he was in medical school, as he believed there had to be a better way to care for patients than the status quo. The human body has incredible healing capabilities…
Foot pain can be debilitating. Dr. Schultz discusses the 7 major causes of foot pain, traditional treatment options, stem cell treatment options, the different types of stem cells, factors that will influence the specific stem cell treatment plan, and the advantages of stem cells over steroids and surgery.
Introduction Today we’re going to be talking about how to treat tibial nerve injury. We’ll be discussing exactly what is the tibial nerve is, the muscles the tibial innervates, how the nerve can be injured, as well as potential treatments for this. So let’s start off with what muscles are innervated by the tibial nerve.…
Morton’s Toe vs. Morton’s Neuroma – A small course on what they are and what can be done to treat them. Transcript Dr. John Schultz Hi, everybody. This is Dr. Schultz with the Centeno-Schultz Clinic. I thought we’d have a little fun today. You know, summer’s here and we’re having fun. Some of us are…
Foot pain can be crippling. Where is Navicular Bone? Why Does my Navicular Bone Hurt? How do you treat Navicular bone pain? Let’s dig in. Where is Navicular Bone? There are 26 bones in the foot. The Navicular Bone is a small C-shaped bone located on the inside portion of the midfoot. It is nestled…
Ankle pain can be excruciating often times making a simple step almost impossible. What is a Talonavicular fusion? What are the indications for a Talonavicular fusion? What are the complications from a Talonavicular fusion? What does life look like after talonavicular fusion? Let’s dig in. Foot Anatomy The foot is compromised of 26 bones. The…
Heel pain in the morning can make the first several steps excruciating. Given that, what are the causes of pain in the heel? What is plantar fasciitis? Can plantar fasciitis go away on its own? Are steroid injections helpful? Let’s dig in What Causes Pain in the Heel? Heel pain is a common foot disorder…
2.Doral MN, Alam M, Bozkurt M, Turhan E, Atay OA, Dönmez G, Maffulli N (May 2010). “Functional anatomy of the Achilles tendon”.Knee Surg Sports Traumatol Arthrosc. 18 (5): 638–43.doi:10.1007/s00167-010-1083-7
