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A 13 year old girl, rides and does various running-based team sports, complaining of pain afterwards (though max 24 hours) "in my heels" (Achilles attachment it seemed).

She was tight in her hamstrings and, for her age, in gastrocs and soleus. I advised the edge of the stair exercise and a hamstring stretch.

My question though is whether, at this age particularly, there would be benefit (or hazard) in deliberately opting for very flat shoes. She says she wears a shoe like a trainer to school, so appears to be almost never in a flat shoe. I know there are different schools of thought about minimalist trainers and ballet pumps, I just wondered what you thought about maybe it being a more effective way of stretching than issuing exercise that might not be done? Presumably if there's any merit at all in the idea, it wold be best to start with the walking shoe and leave the sports shoe til any symptoms had gone?

Her mother mentioned that she (the mother) had ruptured both her Achilles in the past.

Thanks for any thoughts.

Lucy

 

Do you think that the heel pain is caused by an early heel off in gait, limited ankle dorsiflexion, or from the activities that she participates in, or all? If you think that the heel pain is caused by limited ankle dorsiflexion, then you are caught between the immediate need to reduce tension in the tendon to allow it to heal and the long term wish for increased range of motion of the ankle joint. When I looked at the literature many years ago there was debate whether you could actually increase range of motion of the ankle joint with stretching. On the other hand those stroke patients do lose ankle dorsiflexion when they are not stretched. Certainly, until symptoms are reduced, I'd go with a shoe with a lift to reduce tension when standing.

Did you ask her mother what she was doing, and how old she was, when she tore her Achilles tendons? Not a story you get from your average mother.

Eric

 

If the girl is diagnosed with calcaneal apophysitis, there are a number of recently published RCTs and a 2013 JFAR systematic review. Don't know to what extent these studies are specifically applicable to adolescent female athletes, but, as far as I remember (may be wrong) none looked into flat shoes as a stretching modality or the mainstay evidence-based treatment for Sever's; all or probably most found heel raises to be effective in the short term, no long-term difference in pain reduction between different interventions or no intervention.