A Better Approach to Tendinitis and Heel or Foot Pain

When Therapy, Injections, and Surgery Don’t Help
Mrs J was in her 60s and came to see me complaining of pain in both heels. She had been an active woman, working full time, going to the gym to exercise 3-4 times per week. Prior to developing pain, she used to walk up and down from the 4th floor where she worked each day as an admininstrative assistant. Roughly 2 years prior to seeing me, she began having pain in her heels. She was seen by an orthopedic surgeon who diagnosed tendinitis in her achilles tendons. He prescribed an anti-inflammatory medication and she had physical therapy with stretching, ice, and ultrasound. She got better for awhile but the pain returned, worse than the first time. The surgeon did cortisone injections into her tendons. The pain improved for awhile and then recurred. Then the surgeon cut her achilles tendons to lengthen them, assuming (I suppose) that the problem was that they were too short! Not surprisingly, her pain didn’t really get better enough to allow her previous activity and function, despite several months of physical therapy.

Why Medicine Needs a New Perspective
I heard the history, and the surgeon’s diagnosis and treatment plan just didn’t add up.

She hadn’t had any known trauma, change in activity, or change in footwear. Why would her achilles tendons suddenly get dysfunctional at age 60 when she had been been exercising and active, going up and down 3 flights of steps daily? But that’s part of the difficulty with the diagnostic and treatment approach that I learned in medical school and done by most MDs. In that system, the principle of unity of the musculoskeletal system is not well-understood. With a few exceptions, the location of pain is seen as the location of ‘the problem’. But given the lack of inciting injury or illness, he should have been thinking differently. Clearly there was another problem, because her tendons continued to hurt despite the best orthopedic care.

A Better Understanding Brings a Better Treatment
She lay on her back on the treatment table and I put my hands on her feet, ‘listening’ to her whole body, as my osteopathic mentors have taught me. My attention quickly and consistently was drawn to the area of her pelvis. When I put my hands on the rims of her pelvis and sensed the inherent tissue motility, it felt extremely chaotic and disorganized. The normal motion was not present. I asked her if anything had happened to her pelvis in the past few years.
‘Well, I had bladder suspension surgery about 3 years ago’, she said. ‘How long after that did you start having pain in your heels?’, I asked. “About 6-8 months after that….”

Sure sounded like a good answer to me.

The BodyMind is One Interconnected System
In osteopathy, we understand that the body functions as a unit. The body has a normal motility, or involuntary motion to it. The midline structures like the spine are moving in extension and flexion, and the paired structures move in external rotation and internal rotation. The whole system moves together. What I sensed in her pelvis, was a distortion in the system. This case was a great example of the unity of the bodymind. Because of the fascial connectivity, the dysfunction in her pelvis contributed to dysfunction and overloading of her achilles tendons, which became painful over and over again.

Osteopathy and Other Manual Treatments can Re-establish Normal Function
I treated her a few times and there was improvement. It seemed like she needed more focused treatment to the soft tissues of her pelvis. Based on her preference to have her pelvis treated by another woman, I referred her to a colleague who was a physical therapist trained in manual therapy. Treatment consistent of releasing the scarring in the connective tissue in the pelvic organs, and normalizing the mechanics of the low back, pelvis and legs. Within about 3-4 weeks she was able to walk without pain. Within 2 months she was going up and down stairs without pain, without drugs, without injections or surgery.