Achilles Tendon and Calf Pain

Why does calf pain happen ?

The calf muscle is comprised of two separate muscles, the big belly muscle on the upper half of the rear of the leg called gastrocnemius and a broader flat muscle that lies deeper inside called soleus. These have both the muscular component that you can tighten by flexing and a tendonous part.

The Achilles tendon begins just under the belly of the calf muscle and goes all the way down to attach to the back of the heel bone.

The calf muscle is longest when the foot is in perfectly straight position, not rolled in or out.

When the foot is perfect, every step you take uses the calf muscle to the full, normal length. When the foot is not perfect, usually when it is rolled in or pronated, the muscle doesn’t get stretched all the way out often enough and becomes shortened. When you need to get more length out of it (for example, to walk barefoot, run or walk more quickly or to walk uphill) the required length isn’t there and Achilles or calf pain occurs.

Pain can occur anywhere within the two muscles or the Achilles tendon but happens most often in the cord just above the heel bone or in the medial (big toe side) belly of gastrocnemius.

Things you can do:

There are ultimately only two things that make this better. You can either lengthen the muscle or stop asking it to do movements that it can t do. Assuming that you don t want to sit down for the rest of your life, some effort will be required to stretch this muscle out. See the diagrams below of the two stretches you will need to do regularly. Doing only one generally won’t work. It is very important to do these exactly right as your body will try to cheat and avoid stretching the muscle. Use the diagrams, keeping the following points in mind.

• Put all of your body weight on the back leg and push the heel into the floor.

• Don‘t let your arch sag in. Keep your foot pointing directly at the wall. Keep your knee pointing directly at the wall and over the top of your foot. This is where your body will try to cheat by pivoting away from these positions.

• Don‘t bounce, get into maximum stretch position and hold it there for 20 seconds. There are four exercises to do, two on each leg. Doing them five times each will take you six minutes. This will seem like a long time!

• The exercise will hurt when you get it right. When the stretch causes pain in the place where you are complaining of pain, that is where you especially need to be.

• You can stretch before you do an activity which will generally make it less painful to do. You can stretch during or after an activity which will have more long lasting effects. For best results, do both.

• The two stretches below are the same except that the first diagram shows the rear leg bent at the knee and the second shows the rear leg straight at the knee.

• Wear lower heeled shoes most of the time, about 1 cm thicker at the back than at the front is ideal. To avoid pain for a particular activity, add a bit of height to the heel around 2-3 cm is ideal. This could include a thicker jogger or a pad under the heel in your existing shoes. Don t do this all the time though, as it will ultimately make the problem worse.

• Don’t bother pulling your foot backwards to feel a stretch . The thin muscle on the front of your leg is no match for the much bigger calf muscle and can’t overpower it.

What the podiatrist will do:

The first thing the podiatrist will do is check that the diagnosis is correct. There is another disorder called intermittent claudication that can be confused with this. If you have a history of heart disease or artery problems, ask your doctor for that sheet also or come to see us directly.

The podiatrist will tell you to do these exercises and check that they are being done correctly. A heel raise for shoes will often be provided to you and strapping may be applied. These are the things that will get you feeling better quickly. In cases where calf pain has been present for some time Extracorporeal Shock Wave Therapy may be utilised.

Most importantly for the long term though, is to assess foot position. If it is found that a fault in the foot is to blame for the shortened calf muscles, it should be fixed by way of a functional orthotic device. The alternative is to need to do the stretches forever to keep the pain away.