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…
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…
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 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.
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)
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.
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
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…
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.
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.
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…
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.
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