Last month, my family traveled to Guatemala for Spring Break. One of the highlights of the trip was hiking Pacaya Volcano near Antigua. It is a rather steep volcano, so we took what the locals call the “taxi” on the way up—each of us rode a horse. On the way back down, I decided to hike with my own two feet.
A few weeks later, I started having bad pain that I knew originated in my left Achilles tendon. The Achilles tendon is a large tendon in the leg that originates from the gastrocnemius and calf muscles and inserts into the calcaneus bone at the back of your ankle. It plays an important role in using the ankle and walking.
My pain had developed gradually and I did not hear the characteristic loud pop from a rupture or tear of the tendon. The only thing I could figure out as the cause was hiking down the volcano in flat tennis shoes, which I can now assure you is not a good idea.
After a few days, I made an appointment with a podiatrist.
As a Houston, Texas medical malpractice lawyer, I could not resist doing some basic research on what to expect. One of the things that I found is that some podiatrists and physicians recommend a cortisone injection to reduce inflammation. This is negligence and a violation of the standard of care, because it can cause an inflamed tendon to rupture.
When I saw the podiatrist, he did not make this recommendation, which was reassuring. Instead, he did some ankle x-rays and confirmed my suspicion that I did not have a torn or ruptured Achilles tendon, but was just suffering from Achilles tendinitis. He prescribed a prednisone medication to reduce inflammation and an expensive boot that would immobilize my ankle and allow the tendon to rest and heal.
Two weeks later, I had a follow-up appointment. My ankle was feeling a lot better. After an examination, the podiatrist said that I could start the process of weaning away from the boot and do some exercises. I asked for some instructions on the exercises and he gave me a sheet of exercises designed to strengthen the calf. He advised me to do them several times a day, which I did.
I followed the podiatrist’s instructions and stopped wearing the boot continuously. I also did the recommended exercises several times a day. I noticed that the exercises made my ankle feel tight, but figured that it was part of the process. Within a few days, though, my Achilles tendinitis pain returned with a vengeance.
At that point, I started to question the podiatrist’s advice and started doing my own research. This is exactly what I do in investigating a potential medical negligence case, as a Houston, Texas medical malpractice lawyer.
Two types of Achilles tendonitis
From my research into the medical literature, I learned that there are two types of Achilles tendonitis.
The most common type is non-insertional Achilles tendonitis, which affects the middle part of the tendon, when fibers begin to break down with small tears, followed by inflammation and thickening.
The less common type is insertional Achilles tendonitis, which affects the tendon where it inserts into the calcaneus bone in the back of the ankle. This is certainly the type that I had, because even gently touching that spot was quite painful.
The medical literature reflects that the exercises used to remedy Achilles tendonitis differ, depending on which type the patient has. One of the key factors for insertional Achilles tendonitis is the compression that occurs when the ankle reaches the end of its dorsiflexion (upward movement) range. On the other hand, for non-insertional Achilles tendonitis, tensile loading is more the problem.
I was surprised and alarmed to find that the exercises my podiatrist recommended to me was for the wrong type of Achilles tendonitis, and was actually causing further irritation of my insertional tendonitis. He recommended calf-stretching exercises, which are helpful for the other type of Achilles tendonitis.
Two days ago, I started doing the correct exercises— going on my tiptoes and holding that position for one-minute repetitions—and my condition rapidly improved and the pain went away.
What you can do
My personal story illustrates the importance of being repetitive when it comes to speaking with your physician. While your condition, signs, and symptoms are at the forefront of your mind, that may not be the case with your doctor.
In my case, I suspect that the podiatrist had not reviewed his notes from our previous visit and he made general recommendations that, while good for some patients, were harmful to my condition.
Both in hospitalizations and office visits, I recommend that you repeat what is going on with your condition each time you see your doctor, physician assistant, or nurse practitioner. Make your description precise and thorough. This will help your healthcare provider direct attention to you, as a specific person and patient and, I believe, it improves your odds of having a safe healthcare experience.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. In 2017, H Texas magazine named him one of Houston’s top lawyers. Also in 2017, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.
