Achilles Tendon Pain - High School Runner

Abstract

HISTORY: A 15-year-old female HS runner and basketball player presented with Achilles tendon insertion pain and popping that forced her to stop running for her HS track team over the previous 2 weeks. Her pain was 7/10 when she ran. She was able to cross train on the Elliptical machine and bike. She played soccer for 11 years and transitioned to cross country (CC) running 8 months prior to her visit with mild Achilles pain early in the season. She ran all her varsity CC races (4K time of 15:05). She played varsity basketball without problems. She was still growing in height. PHYSICAL EXAMINATION: Healthy appearing, thin young woman with muscular legs. She was tender bilaterally to palpation at the Achilles tendon insertion with a painful bump on the lateral edge of the heel; worse on the right. Calcaneal and forefoot valgus joint motions were tight with moderate mechanical subtalar and mild metatarsal and cuneiform restriction. Foot dorsiflexion was <10°, but painless and strong. Her left PSIS was lower than the right with a painful spasm in her left lower quadrant medial to the anterior iliac spine. Her straight leg raise was limited to 45° on the left and 60° on the right. Resisted hip adduction was weak and painful in the groin. DIFFERENTIAL DIAGNOSIS: 1. Mechanical dysfunction of the SI, lumbar and ankle/foot joints 2. Achilles tendonosis 3. Muscle strain Diagnostic Imaging: None FINAL/WORKING DIAGNOSIS: Mechanical dysfunction of the SI, lumbar, and ankle/foot joints with associated pain and spasm TREATMENT AND OUTCOMES: She was treated with manual physical therapy weekly during month 1 and every other week in month 2. Joint mobilization, PNF diagonals, side lying rotation, and longitudinal traction were used in the resting position to decrease the mechanical restrictions at the SI joint, lumbar joints at L2 through S1, and ankle joints. Her straight leg raise increased to 90° and dorsiflexion increased to >10° bilaterally. She had no tenderness with palpation to her Achilles tendons bilaterally. She returned to light running after the 2nd treatment and following 4 treatments she was able to fully participate in all her track practices and meets. She ran on her 4×400 relay team at the State Track meet 8 weeks after her initial visit without pain. Four months later she participated in her second HS CC season and placed first in several races.