ACHILLES TENDINITIS

Achilles tendinitis is one of the most common overuse injuries in athletes and physically active people

About Achilles Tendinitis

Achilles tendon pain affects your gait and increases your risk of injury during running and sports. If left untreated, overuse injuries to the Achilles tendon can lead to irreversible damage that undermines performance and leads to further injury. At NYDNRehab, our treatment toolbox includes ESWT (shockwave therapy), ultrasound-guided dry needling, Kineo Intelligent Load system, eccentric loading, plyometric exercises and retraining with real-time contextual feedback. Contact us today to eliminate Achilles pain and restore full function to your foot and ankle, so you can get back to the game of life.

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Is the Achilles tendon really inflamed?

Studies show that there are no inflammatory cells present in patients experiencing pain in the Achilles tendon. Therefore this condition should properly be named Achilles tendinopathy. The word tendinopathy means that there is a degeneration of the tenocytes (tendon cells) in the Achilles tendon.

Types of Achilles tendinopathy

Non-insertional: Small tears in the middle fibers of your Achilles tendon begin to break down

Insertional: Damage occurs where your Achilles tendon meets your heel bone

Achilles tendon anatomy

Also called the calcaneal tendon

Shared by the gastrocnemius and soleus muscles of the calf

Connects the calf muscles to the heel bone

Releases elastic energy during running and jumping

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Risk Factors

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Intrinsic
  • Reduced ankle dorsiflexion
  • Reduced subtalar joint range of motion
  • Weak plantar flexor muscles
  • Excessive foot pronation
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Extrinsic
  • Antibiotic medications
  • Diabetes mellitus
  • Metabolic syndrome
  • Arthritis

DIAGNOSIS

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In addition to reviewing your medical history and conducting a clinical exam, we use high resolution diagnostic ultrasonography to assess the injured area. Ultrasound imaging lets us view the damaged tissues in real time, with the injured area in motion. The patient becomes an essential participant in the diagnostic process, repositioning the foot and ankle as needed, and providing verbal feedback. Ultrasonography gives us real-time results, so we can begin treatment as quickly as possible.

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Prognosis

According to research, young physically active people respond more quickly to treatment than middle-aged or older adults. For younger patients, treatment takes about 3 months. Rehabilitation is typically double that for older patients.

NYDNRehab Technologies for Diagnosis and Treatment

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Aplio i800 ultrasound

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STORZ MEDICAL shockwave

Achilles Tendon Treatment Options

We use innovative treatments and therapies based on scientific evidence and clinical results

NYDNRehab takes a holistic approach to treatment, combining the best treatment options based on the individual patient and the specifics of their injury.

NYDNRehab provides a treatment based on a combination of such methods as:

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Extracorporeal Shock Wave Therapy
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Eccentric loading
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Taping – insertional type
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Manual therapy

Laser and Iontophoresis, ultrasound, steroid injections, plasma injections – all have very low to no scientific evidence.

Kineo

The most versatile muscle testing system using artificial intelligence
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Lev Kalika Clinical Director and DC, RMSK

Dr.Kalika has revolutionized Achilles tendon care by using high resolution diagnostic ultrasonography for structural diagnosis, combined with gait and motion analysis technology. The NYDNRehab motion and gait analysis lab is the only private lab in the US to feature research-grade technologies found only in the world’s top research labs, and made available to patients in our private clinic. Dr.Kalika’s modern approach to athletic Achilles tendon injuries has put him on the radar of some of the world’s top distance runners, pro athletes and professional ballet dancers.

Our Specialists

Dr. Mikhail Bernshteyn MD (Internist)
Dr. Christina Pekar DC
Dr. Michelle Agyakwah DC
Mariam Kodsy Physical Therapist
Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

Achilles Tendonitis Doctor at NYDNRehab

At NYDNRehab, we have extensive experience treating Achilles tendinopathy in runners, athletes and non-athletes. Based on sonographic imaging and running gait analysis, we create individualized treatment plans specific to the needs of each patient. Treatment options vary, depending on the type and stage of Achilles tendinopathy. Treatment may include: manual therapy, eccentric muscle loading, ESWT (shock wave therapy), force production exercises and Kineo intelligent loading exercises. ESWT and eccentric loading are shown by research to provide the best results for Achilles tendinopathy.

View Our Treatment Methods

Testimonials

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

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Separation of muscle ends due to tear elicited
on dynamic sonography examination

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