Can Proper Footwear Help Prevent Achilles Tendinitis?

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When a patient has chronic tenosynovitis, you may see nodules form in the tendon that place the tendon at greater risk for rupture.
If you’re examining a patient with chronic tenosynovitis, you may notice inflammation within the tendon sheath and bulbous swelling within the tendon.
In obtaining an MRI of a patient with acute paratenonitis, you may see thickening of the paratenon as shown above.
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A ruptured Achilles tendon can be problematic in many respects for athletically-inclined patients. Not only will they undergo surgery to repair the tendon, these patients face a long recovery period and extensive rehabilitation in order to get back to normal, according to the American College of Foot and Ankle Surgeons (ACFAS).
However, perhaps emphasizing the proper athletic footwear can help athletes prevent these injuries in the first place.
“The type of shoes the athlete wears makes a huge difference,” explains Eric Feit, DPM, a Fellow of the ACFAS. “Any shoe which is soft or compressible on the medial aspect of the heel and midfoot will encourage abnormal pronation. Therefore, shoes which are designed as anti-pronation shoes will be the best.”
According to Dr. Feit, examples of anti-pronation shoes include the Asics gel MC, the Brooks Beast and the New Balance 900 series.
“Out of these three, the Brooks Beast is the most supportive and minimizes abnormal late stance pronation the best,” adds Dr. Feit.
Since Achillies tendinitis is essentially an “overuse syndrome,” Patrick DeHeer, DPM, says the right type of athletic shoe is dependent upon the foot type of your patient.
“An over-pronator would benefit most from a more stabilizing shoe while a cavus foot type would benefit more from a better shock-absorbing shoe,” points out Dr. DeHeer, a Fellow of the ACFAS.
It’s also important to recommend footwear that can handle the specific demands of the particular sport or activity. Dr. Feit says joggers or runners can develop Achilles tendinitis due to an abnormal “whipping” effect on the
tendon that occurs during running.

Dr. DeHeer, a team podiatrist for the Indiana Pacers, says it’s critical to pinpoint and address any underlying causes of Achillies tendinitis first if you want shoe therapy to be successful.
“Most Achillies tendinitis in elite athletes is due to an underlying equinous deformity that often results from calf hypertrophy without adequate stretching,” notes Dr. DeHeer. “Unless you treat this, shoe therapy will have little impact.”n
Is Topical Hyperbaric
Oxygen Therapy Effective?
While there has always been mixed opinion about the effectiveness of hyperbaric oxygen therapy (HBO) in wound care, the topical version of this modality stirs up even more debate about efficacy.
John DelMonte, DPM, has been using the Topical Hyperbaric Oxygen Extremity Chamber (Advanced Hyperbaric Technologies, Inc.) for over a year now to help treat wounds. The device enables you to provide direct treatment to non-infected “wounds that need more oxygen to granulate better,” explains Dr. DelMonte.
In treating his patients with this modality three times a week, Dr. DelMonte has seen “granulation tissue that looks fantastic.”
He also notes that the device is more conducive to patient compliance and is less expensive as well. Dr. DelMonte points out that you can use the device in a regular treatment room as opposed to sending the patient to a hyperbaric lab.
However, some doctors remain skeptical. While there is a lack of research on HBO in general, Robert Snyder, DPM, says most of the literature on portable HBO is “totally anecdotal.”
Dr. Snyder also notes emerging evidence, which suggests traditional, full-body HBO “may stimulate receptor sites and allow them better access to growth factors.”
“This may be the reason why (traditional HBO) gives more than a transient effect when the patient is removed from the chamber,” says Dr. Snyder. “There is no evidence that topical HBO does the same.”n
Editor’s Note: For more information on the Topical Hyperbaric Oxygen Extremity Chamber, contact Advanced Hyperbaric Technologies at (800) 327-4325.

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