Can the Achilles tendon harden with calcium?

pain on the back of the heel

Calcium is a mineral that makes up a large portion of the structure and ‘hardness’ of bones.  However, softer tissue like muscles and tendons can develop deposits of calcium mineral in a process called calcification.  The important Achilles tendon is equally at risk for developing calcification as any other tendon or muscle, and perhaps more so due to its strength and the way it pulls on the heel to bring the foot downward.  This process can start simply due to increased traction on the tendon’s attachment on the heel bone when it is tight, or due to injury to its fibers.  The damaged tissue can eventually host calcium deposits which can be seen on x-rays.  To be clear, this calcification process is not the formation of bone, but rather small groups of calcium that are solid enough to appear on x-rays.  They appear as fluffy white patches small and large across the back of the heel away from the heel bone.  These calcifications can even look like a fractured bone spur if they are grouped close to the heel bone, sometimes leading to misdiagnosis.

The calcifications themselves are not generally a source of pain in the Achilles tendon and heel, but are usually the result of the damage and inflammatory process that creates the original pain.  These calcifications are generally the result of long term tendon damage, and represent a chronic process that began before the calcifications appeared.  However, if a new acute injury occurs to the Achilles tendon after calcification begins, it is possible the freshly injured tendon fibers can be even more irritated by the surrounding calcified tissue.

Unfortunately, there is no way currently to destroy or effectively break up the calcified tissue when it is spread diffusely, and attempts to surgically remove it may lead to further Achilles tendon damage and inflammation.  Smaller areas of calcification can be cut out though, and special graft tissue can be used to reinforce the tendon to help reduce the chance of weakening following such surgery.

Don’t Ignore Achilles Tendonitis and Pain In the Back of Your Heel

pain on the back of the heel

The Achilles tendon- a potential weak point of many an athlete and warrior.  It can hobble the mighty, and make life difficult for anyone unfortunate enough to injure it.  So-named for the weakest part of the great Greek warrior Achilles, who was invulnerable through being dipped into the river Styx at birth, except for the back of the heel where he was held.  Many professional athletes have been felled by this tendon, and many more non-athletes develop his condition with negative consequences to their lives.

The Achilles tendon is a large tendon located on the back of the heel.  It is incredibly important, and imparts a significant amount of the movement the foot has on the leg.  When this tendon is ruptured, walking becomes nearly impossible as the foot simply flops upward when the body puts full weight on it.  Even when only strained, the Achilles tendon can limit walking due to significant pain.  Inflammation of the Achilles tendon, called Achilles tendonitis, is very common and is seen in athletes, older people with chronically damaged tendons, those taking certain medications that weaken tendon fibers, and those with spurs on the back of their heel bones.  Symptoms can either be acute, meaning that they suddenly develop due to a specific injury, or chronic, meaning that the injury has developed over a long period of time due to gradual tendon strain.  The symptoms run a range from a sharp pain to the back of the heel when the foot bends upward, to a dull ache during any ankle motion.

As Achilles tendonitis worsens, the strain placed on the tendon can weaken it, potentially leading to a rupture at the worst and long term pain in the least.  An athlete with Achilles tendonitis can see an immediate and severe decrease in their performance, and non-athletes can see a significant disruption in their daily lives and ability to perform at work.  If untreated, Achilles tendonitis can be long-term and very disabling.  I treat many cases of Achilles tendonitis, and have seen the havoc this condition place on an individual.  If you are developing pain to the back of your heel, stop your activity and rest.  If it continues, go see a foot specialist for treatment.  Even simple tendonitis cases often worsen if not treated properly from the start.

Did you know you can get bursitis in your heel?

heel bursitis pain

While most cases of pain on the bottom of the heel are caused by plantar fasciitis, some are not.  A common alternate cause of heel pain is a condition called bursitis, and it can lead to severe pain directly on the bottom of the heel.

Bursitis is inflammation of a bursal sac, which is a pad of tissue that can be found throughout the body, protecting bony prominences as well as other sensitive tissue.  In the bottom of the heel, the bursa is not necessarily a naturally occurring object.  In general, unlike many other bursas, this bursa is more reactive, meaning that it forms as a result of abnormal pressure and irritation under the heel.  The bursa becomes irritated when the heel bone of a person with a flat foot rotates excessively as it will naturally do during walking, generally exposing the bottom of the heel tissue to a more irritating part of the heel bone that is not usually prominent on the bottom of the heel.  Eventually, a bursal sac will form to protect the irritated soft tissue under the heel bone, and in turn this will become irritated itself.  Other causes for bursitis include walking for extended periods on rocky or bumpy surfaces, high arched feet with poor shock absorption capabilities, as well as poor heel fat pad in older people with a prominent heel bone resulting.  I have even often seen this condition in people who have a more angular shape to the bottom of the heel bone as opposed to a more normal rounded shape.

Bursitis can often be present at the same time as plantar fasciitis.

Treatment of bursitis under the heel is relatively simple.  Steroid injections often take care of the inflammation in and around the bursa, usually more effectively than anti-inflammatory medication taken orally.  Ice helps, as well as increased shock absorption via gel heel inserts or orthotics with soft heel padding.  Surgery is typically not an option, as the attempt to find and remove the bursa can lead to more damage to sensitive tissue such as nerve bundles within the heel, making things worse.

Avoiding Heel and Foot Pain With Sandals

sandals

As the weather begins to gradually warm, many people begin the annual migration from enclosed shoes to sandals.  Sandals feel great when the weather is hot, and are very easy to put on and slip off.  Sandals range in build from minimal flip flops to all terrain sports sandals for light hiking  It is an unfortunate fact that some people will gradually injure their feet while in sandals over an extended period, especially the heels.  This injury can take a long time to develop and may not even be noticed until the late summer or early fall, but will cause pain and activity limitation regardless.  This can be avoided by being sensible with one’s choice of sandals, and I would like to offer some advice on how you can still enjoy sandals in the summer without developing pain.

The reality of the situation is that many sandals manufactured today, as in the past, are not very supportive.  Most sandals have flat or thin soles, and flip flop sandals in particular do not stay on the foot well.  Over time, the force applied to the arch of the foot will lead to strain of a ligament on the bottom of the foot known as the plantar fascia.  Once strained, this ligament becomes inflamed and can tear microscopically.  This then leads to more significant pain as the strain continues and the plantar fascia is unable to heal.  People who have lower arches, as well as people who have higher arches tend to more easily injured.  Those with so-called ‘normal’ foot structures can also injure the plantar fascia, just not as easily,

There is a way to avoid this strain altogether and still be able to wear sandals in the summer.  The key is to select sandals that are better constructed to contour the arch and lend more support.  While traditional and fashion sandals do a poor job of this, a newer generation of support-minded sandals are sold in stores everywhere which feature a raised arch bed that cradles the arch and reduces strain to the plantar fascia.  These types of sandals have a much less likelihood of generating strain to the arch, and are much better for the feet.  Traditional strappy flat sandals and inexpensive flip flop sandals should be avoided in general, outside of around the pool or on the beach.  Anyone with a history of heel or foot pain should be especially careful in their selection of sandals.  In central Indiana, there are a number of quality shoe stores that carry these better products, and while they may cost more they will be well worth it in maintaining a foot pain-free summer.

If you happen to develop heel or foot pain after wearing sandals, it is very important you seek treatment.  Plantar fascia injuries and other types of foot pain caused by strain are generally easy to treat, but often will not simply go away on their own.  Many people make this assumption, leading to pain that can last for months to years.  Be sure to see your local podiatrist if you have any questions on what kind of sandal or footwear is right for your foot, or if you start to develop heel or foot pain over the course of this summer.