Today, 16th June 2017, sees National Flip Flop Day! (Yes, that really is a national day!!) With the wonderful weather this week and set to be beautiful over the weekend, flip flops are are common footwear of voice!
Flip flops are great for chucking on to get from the car to the beach and walking around the pool. But this footwear is playing havoc with our feet!
In the summer months we see so many people coming into the clinic with foot and ankle problems such as achilles tendonitis and plantar fasciitis. In many of the people with knee, hip & back problems that come to see us, we also find that a sudden increase in wearing flip flops for long periods of time has played a part in their problem.
Flip flops provide no support for your feet, they are often made of very flexible rubber with little additional structure to hold your foot in place. This causes considerable stress to your feet as you rely on your toes to grip with every step and the additional stress placed on your plantar fascia, achilles tendon and other structures in your foot.
So, if you’re going for a longer walk or going to be on your feet all day, ditch the flip flop and wear something more supportive. If you’ve noticed you’re suddenly getting pain in your foot ankle or other part of your leg or back and have been wearing flip flops more now the sun is out, try reducing how much you wear them and see if this makes a difference.
The most common cause is repetitive ‘micro’ trauma to the tendon or overuse. The repetitive strain can result in a chronic Achilles tendinopathy, where there is a gradual breakdown of the tissue of the tendon. You might have heard it as tendinitis previously. It can either affect the middle portion of the tendon or the point where the tendon inserts into the heel bone.
What might Achilles Tendinopathy feel like?
Mild to moderate pain and stiffness around the back of the heel in a grade 1 or 2 strain. The more severe the strain, the more severe the symptoms would tend to be.
Swelling or a small lump on the Achilles tendon in a grade 1 or 2 strain.
Tightness into the calf muscles.
A complete rupture (grade 3) is often characterised by a ‘pop’ with immediate pain and an inability to bear weight through your foot.
How do the symptoms of Achilles Tendinopathy progress?
A mild Achilles tendinopathy can resolve itself with relative rest and POLICE pretty quickly.
A more moderate strain or mild strain that lasts more than a few weeks, usually needs some input to fully resolve.
If left untreated, Achilles tendinopathies can develop into a chronic problem leading to permanent changes to the structure of the tendon, with scar tissue forming. In non-traumatic cases, if you don’t do something to address the cause, it is unlikely resolve.
A grade 3 complete rupture will require surgery or conservative management in the form of immobilisation in a special boot or cast.
How is Achilles Tendinopathy diagnosed?
A Physiotherapist will be able to diagnose an Achilles tendinopathy from a thorough assessment. This will include taking a detailed history to identify the potential cause of the problem, analysing muscle strength and length, looking at your foot biomechanics, looking at your kinetic chain (so this is the link between your foot, knee & pelvis to see how they work together), linking this into your activity levels and sports.
Occasionally, you may be referred for an ultrasound scan if the Physio is concerned about a possible tear or rupture to the tendon. This is normally quite obvious when it happens but we’ve certainly had a few through the clinic over the years that we’ve diagnosed with a complete rupture and sent straight to A&E.
What is the best treatment for Achilles Tendinopathy (Grade 1 & 2)
Addressing the cause in non-traumatic cases is key. Your Physiotherapist will be able to help you with this once they’ve identified the root of the issue.
Physiotherapy – this will help reduce scar tissue formation and improve the rate of healing. It may consist of manual soft tissue work, electrotherapy, taping and specific exercises.
Selective rest – avoid any high impact activities and take a break from any aggravating sports or activities to allow the injury to recover.
Ice – helps to manage the pain and swelling
Painkillers – allows you to keep moving and do all your Physio exercises!
Orthotics – if foot biomechanics are contributing to your Achilles problems, a GaitScan to identify any issues and a pair of orthotics will address this to stop the problem reoccurring.
Prognosis for Achilles Tendinopathy
With early and appropriate treatment, Achilles Tendinopathy issues tend to resolve within 8-16 weeks.
Chronic problems may take up to 6 months to resolve.
Products that may help Achilles Tendinopathy
Can Achilles Tendinopathy be prevented?
Maintaining general health and fitness, maintaining muscle strength and flexibility throughout your whole body, can be a good way of preventing injuries such as tendinopathies. Paying special attention to your training regime and programme if you take art in regular sports such as running, is really important. Too much, too soon, too far, too often, can all increase the risk of a tendon problem. Allow your body time to adjust to the demands you place upon it.
If you do start to feel a niggle, don’t ignore it. The longer you leave problems like this without addressing the cause, the more severe they can become.
Think about your footwear too, wearing good quality, supportive footwear at all times can help prevent Achilles tendinopathy.