The Achilles tendon is a highly tensile structure that can absorb up to 12.5 times our body weight1. Ironically, development of pain around the area of the Achilles tendon is very common. Oftentimes, it is associated with repetitive movements that shorten and lengthen the tendon (i.e. running). However, other risk factors have been seen to possibly play a bigger role in development of this condition, such as systemic diseases like type 2 diabetes.

Studies2 show that individuals with type 2 diabetes develop thickening and/or stiffening of the Achilles tendon leading to heel or foot pain and changes in gait. Changes in other structures, such as (but not limited to) muscles, blood vessels, and the skin are also possible. These alterations can result to degenerative deformations. Specific to the Achilles tendon, the relevance of these findings do not 100% correlate with pain. However, other studies show that increased tendon thickness is associated with insertional Achilles tendinopathy3. The reasons for the thickening and/or stiffening of the Achilles tendon are multi-factorial, such as presence of glycation end products which accumulate and cause poor blood circulation to the area4. It’s honestly beyond my scope as a physical therapist and beyond my mental capacity to fully understand, deeming me uncredible to explain on these reasons further.

Treatment and preventive measures for Achilles tendinopathy (heel pain) is how this topic relates to my work as a PT, whether or not you are diabetic. Mechanical changes in the tendon can greatly affect how the whole body functions—either down the line (the foot and toes) or up the line (back, hip, and knee). That being said, it’s important to treat and prevent Achilles tendon pain regardless of the cause.

If you have heel pain, and are diagnosed with diabetes, my suggestion is: treat the root cause which is the abundance of glucose in the blood stream. (My article last week might be more useful to you) More studies5 show that a plant-based diet can cure and prevent type 2 diabetes. So, speaking to your doctor or dietician regarding this might be the best first step for you.

However, I am aware that one plant-based meal will not cure your heel pain. Therefore, the following is the best management to treat acute (and chronic) heel pain[1]:

  1. Concentric and eccentric, strengthening (progress to heavy sooner than later, as tolerated) for the gastroc-soleus complex (the calf muscle)*, and
  2. More physical activity that involves single-leg load bearing (i.e., walking, stairs).

As mentioned, there are many risk factors that cause structural alterations of the Achilles tendon. Other risk factors include age, obesity, and inactivity[1]. These changes in tendon architecture can greatly affect our gait and therefore our functionality in day-to-day activities and tasks. I highly recommend for you to perform versions of the stated strategies above as preventive measures for heel pain, regardless of the presence or absence of risk factors.

Disclaimer: Information from this blog is not intended as medical advice used for self-help or self-diagnosis. The information posted should be regarded as general information based on what Isabel Sison deems as reliable. However, she does not endorse all information posted as substitute to formal medical consultation and treatment. Any change in the information is possible without prior notice.

 

References

1 Alfredson, H., & Lorentzon, R. (2000). Chronic Achilles tendinosis: recommendations for treatment and prevention. Sports medicine (Auckland, N.Z.), 29(2), 135–146. https://doi.org/10.2165/00007256-200029020-00005

2 Khor, B., Woodburn, J., Newcombe, L., & Barn, R. (2021). Plantar soft tissues and Achilles tendon thickness and stiffness in people with diabetes: a systematic review. Journal of foot and ankle research, 14(1), 35. https://doi.org/10.1186/s13047-021-00475-7

3 Aggouras, A. N., Chimenti, R. L., Samuel Flemister, A., Ketz, J., Slane, L. C., Buckley, M. R., & Richards, M. S. (2022). Impingement in Insertional Achilles Tendinopathy Occurs Across a Larger Range of Ankle Angles and Is Associated With Increased Tendon Thickness. Foot & ankle international, 43(5), 683–693. https://doi.org/10.1177/10711007211069570

4 Afolabi, B. I., Idowu, B. M., & Onigbinde, S. O. (2021). Achilles tendon degeneration on ultrasound in type 2 diabetic patients. Journal of ultrasonography, 20(83), e291–e299. https://doi.org/10.15557/JoU.2020.0051

5 McMacken, M., & Shah, S. (2017). A plant-based diet for the prevention and treatment of type 2 diabetes. Journal of geriatric cardiology : JGC, 14(5), 342–354. https://doi.org/10.11909/j.issn.1671-5411.2017.05.009