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The response to the question below was authored by Marc Mitnick DPM

Achilles Pain and possible calf shortening.

by Barb
(Holly Springs, Ga USA)

I was born with spina bifida, repaired, did fine for a long time. I am now 47 and have went through two tethered cord surgeries, the last being in 2009 and I have nerve damage in my spine (adhesive arachnoiditis, syrinx, etc.). Recently I have had a horrible time getting up in the morning and trying to walk because the pain in my Achilles was so bad I couldn't stand to step down on my foot. It would ease up about an hour after being up and moving around. My calf muscle stays very tight because of the spasticity in my leg. It is almost as if I can not keep that leg/ankle still for any length of time. I am constantly rolling it around, turning it in and out, etc. I purchased a dorsal night splint to try to ease the pain of my Achilles tendon. I woke up in the middle of the night in excruciating pain. I felt as if my entire foot was being ripped off. It was more than just a cramp. It hurt from my ankle and encompassed my entire foot. I don't know what is going on with my foot. Why would it hurt so incredibly bad just from being held in the correct position for three hours? :(

ANSWER

Hi Barb,

Because it appears your Achilles tendon tightening is related to a neurological deficit it might be safe to assume that that your problem is a progressive condition and may continue to worsen.
This scenario is

in contrast to a woman who wears high heels her whole adult life and retires from business and now her Achilles tendon hurt when barefoot. That is a functional shortening of the Achilles tendon and it can be assumed no further damage will occur.
Since your case appears to be progressive I would not find it surprising that you are having the problems that you mention.
As the "tightening" worsens, the more discomfort you are going to experience, even in a night splint.
At least during the day while you are walking you are constantly stretching the Achilles tendon so as the day progresses the pain diminishes.
At night even with the splint the Achilles tendon is only being maintained, it is not being actively stretched and I think that would account for the pain you get in the middle of the night.
At some point in time this problem seems as if it is going to require a surgical solution. The problem here is recognizing when the all the shortening that is going to occur, has occurred.
I do not really know the answer to that. Your spinal surgeon might be better equipped to give you that answer.
I would suggest to you that any Achilles lengthening procedure done too soon, might lead to surgical failure.
Your best best right now would be to consult a good foot surgeon in your area and let he or she work in conjunction with your spinal surgeon in determining some direction for you.

Marc Mitnick DPM
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Sep 23, 2011
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by: Barb

Thanks for the response. That was pretty much what I expected to hear. Since my adhesive arachnoiditis is progressive and there is no cure, the likelihood of the calf shortening halting is pretty much non-existent. So I suppose I need to learn to live with that pain like the others, but thank you for the response!

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ADDITIONAL REFERENCES

Mayo Clinic

Johns Hopkins Medicine

MedlinePlus

Arthritis Foundation

University of Rochester Medical Center

Harvard Health

Drugs.com

American Academy of Pediatrics

Penn State Medical Center

National Institutes of Health

Columbia University Department of Rehabilitation

ScienceDirect

Stanford Health Care

Illinois Bone and Joint Institute

Mount Sinai Hospital

Institute for Chronic Pain

University of Florida Health

American Family Physician

Cedars-Sinai

University of Maryland Medical Center

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Achilles Pain and possible calf shortening.

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