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Achilles Tendonitis

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.

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Ankle Pain After Walking

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.

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Ankle Pain When Running

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…

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Pain in Back of Heel

The back bone may not be directly connected to the heel — however, it is connected via the nerve supply. The structures that make up the heel contain nerve branches that are rooted all the way up in the lower back. And that nerve branch is responsible for both sending and receiving signals between the foot (part of the peripheral nervous system) and the spine (central nervous system).This nervous system wiring is, in fact, one massive network, so if our S1 nerve becomes irritated in the lower back, for example, it can affect any structure down the leg—the hip, knee, ankle, heel, and so on. Interestingly, with an irritated nerve…

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Causes of Achilles Tendonitis

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 Stem Cell Therapy for Achilles Tendonitis

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. 

Can BMC Repair Tendons?

Yes!  In 2020 BMC injections for Achilles tendonitis is an option.  There are three types of tendon tears.

Partial Thickness Tear

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

In Conclusion

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…

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John Schultz, MD

My passion and specialization are in the evaluation and treatment of cervical disc, facet, ligament and nerve pain, including the non-surgical treatment of Craniocervical instability (CCI). I quit a successful career in anesthesia and traditional pain management to pursue and advance the use of PRP and bone marrow concentrate for common orthopedic conditions. I have been a patient with severe pain and know firsthand the limitations of traditional orthopedic surgery. I am a co-founder of the Centeno-Schultz Clinic which was established in 2005. Being active is a central part of my life as I enjoy time skiing, biking, hiking, sailing with my family and 9 grandchildren.

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John Pitts, M.D.

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.

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Jason Markle, D.O.

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.

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Matthew William Hyzy, D.O.

Doctor Hyzy is Board Certified in Physical Medicine and Rehabilitation (Physiatry) and fellowship-trained in Interventional Orthopedics and Spine. Dr. Hyzy is also clinical faculty at the University of Colorado School of Medicine in the Department of Physical Medicine and Rehabilitation; In addition, Dr. Hyzy is an Adjunct Clinical Assistant Professor at The Rocky Vista University College of Osteopathic Medicine. Dr. Hyzy also maintains an active hospital-based practice at Swedish Medical Center and Sky Ridge Medical Center. He is also recognized and qualified as an expert physician witness for medical-legal cases and Life Care Planning. He is published in the use of autologous solutions including…

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Brandon T. Money, D.O., M.S.

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…

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Mairin Jerome, MD

Mairin Jerome, MD

Dr. Mairin Jerome is a physiatrist with subspecialty fellowship training in Interventional Orthopedics and Regenerative Medicine. This subspecialty serves to fill the gap for patients who are interested in therapeutic options that lie between conservative treatment and surgery. Dr. Jerome uses regenerative medicine techniques, including prolotherapy and orthobiologics, via X-ray or ultrasound guidance to precisely deliver injections to areas of musculoskeletal injury or degeneration. Orthobiologics refers to tissue harvested typically from a person’s own body, such as platelets (platelet-rich plasma, PRP) or bone marrow, for use in treating painful musculoskeletal conditions. The goal is to stimulate the body’s healing mechanisms to improve pain, function, and decrease inflammation.

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Other Resources for Achilles Pain

  • Stem Cell Treatment for Foot Pain: Learn the Truth.

    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.


  • Tibial Nerve Injury: Symptoms, Diagnosis, and Treatment Options

    Dr. Markle discusses tibial nerve injury – what that means, when you need surgery, and how to avoid surgery. Transcript: Introduction Hello, Dr. Markle of Centeno-Schultz Clinic, and today we’re going to be talking about how to treat tibial nerve injury. We’ll be discussing exactly what is the tibial nerve, the muscles the tibial innervates, … Continued


  • Morton’s Toe & Morton’s Neuroma: What Are They, and What Treatments Are Available?

    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 … Continued


  • 3 Things to Know About Navicular Bone Pain

    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 … Continued


  • Life After Talonavicular Fusion: What Do You Know About this Surgery?

    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 … Continued


  • Heel Pain In the Morning

    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 … Continued


 
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1.Maffulli N, Wong J, Almekinders LC. Types and epidemiology of tendinopathy. Clin Sports Med. 2003;22(4):675–692. DOI: 10.1016/s0278-5919(03)00004-8
 
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 Arthrosc18 (5): 638–43.doi:10.1007/s00167-010-1083-7
 
3.Hubbard, MJ; Hildebrand, BA; Battafarano, MM; Battafarano, DF (June 2018). “Common Soft Tissue Musculoskeletal Pain Disorders”. Primary Care. 45 (2): 289–303. Hubbard, MJ;  doi:10.1016/j.pop.2018.02.006
 
4. Li HY, Hua YH. Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments. Biomed Res Int. 2016;2016:6492597. doi: 10.1155/2016/6492597
 
5.Yang X, Meng H, Quan Q, Peng J, Lu S, Wang A. Management of acute Achilles tendon ruptures: A review. Bone Joint Res. 2018;7(10):561-9. doi: 10.1302/2046-3758.710.BJR-2018-0004.R2
 
6.Lemme NJ, Li NY, DeFroda SF, Kleiner J, Owens BD. Epidemiology of Achilles Tendon Ruptures in the United States: Athletic and Nonathletic Injuries From 2012 to 2016. Orthop J Sports Med. 2018;6(11):2325967118808238. doi: 10.1177/2325967118808238.
 
7. Costa-Almeida R, Calejo I, Gomes ME. Mesenchymal Stem Cells Empowering Tendon Regenerative Therapies. Int J Mol Sci. 2019;20(12):E3002.DOI: 10.3390/ijms20123002.
 
 
9.Kim SJ, Song DH, Park JW, Park S, Kim SJ. Effect of Bone Marrow Aspirate Concentrate-Platelet-Rich Plasma on Tendon-Derived Stem Cells and Rotator Cuff Tendon Tear. Cell Transplant. 2017;26(5):867-78. DOI: 10.3727/096368917X694705.
 

10. Hernigou P, Flouzat Lachaniette CH, Delambre J, et al. Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: a case-controlled study. Int Orthop. 2014;38(9):1811-8.DOI: 10.1007/s00264-014-2391-1. 11. Berger DR, Centeno CJ, Steinmetz NJ. Platelet lysates from aged donors promote human tenocyte proliferation and migration in a concentration-dependent manner. Bone Joint Res. 2019;8(1):32-40.DOI: 10.1302/2046-3758.81.BJR-2018-0164.R1

 

Related: It’s Not Good to Ignore Your Calf Muscle Twitching

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