Complicated Yoga Poses
• The Achilles tendon is an extension of the calf muscles, and inserts into the back of the heel. It fans out across the entire width of the heel. Only the deepest fibers of the tendon attach directly to the heel bone. The others continue around the bottom of the heel and become the Plantar Fascia. So while it is attached to the lower half of the heel directly to the bone, it acts as a strap that wraps around the bottom.
• There is a layer of connective tissue that contains fluid, called a bursa, between the tendon and the upper third of the back of the heel above the attachment of the tendon to the heel bone.
• Those with high arches often have a bump high on the back of the heel. The high arch condition forces the heel bone to be tilted backward into the Achilles tendon, forcing the uppermost portion of the back of the heel bone to rub against the tendon. Eventually, due to constant irritation, a bony protrusion develops. This is called a Haglund’s deformity. While commonly occurring, this can rub more easily on the tendon, irritating it due to pressure from the shoe. This often inflames the bursa which produces redness and swelling associated with Haglund’s deformity. Long-term excessive rubbing on the bone can cause continuous growth of the bump and it can become a very large, easily irritated protrusion.
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• Those with high arches are more prone to Haglund’s deformity and likely to supinate with heels that move at an angle. This outward tilt on the heel will produce a stronger rubbing on the outer portion of the Achilles tendon insertion. The size of the bump on the outer corner will often increase in this case, and is troublesome because it focuses more force on a smaller area. Bone spurs where the tendon connects can also result.
• Those with low arches and no posterior bump can also experience pain in this area, which usually heals more easily.
• The Achilles tendon can be torn where it wraps onto the heel if it is irritated excessively.
• Pain on the lowest part of the back of the heel is a variant of plantar fasciitis. The location of injury is slightly different, but some of the plantar fascia treatments are effective (see the section in this blog).
• Children and teenagers have a softer layer of cartilage in the heel bone that is a growth center. Long bones have this type of growth center called an apophysis: heel, legs, fingers, and arms – unlike flat bones like the skull. It provides a more rapidly reproducing supply of cells than regular bone cells. As they mature, these cells turn into bone, lengthening the bone due to the speed of reproduction. The Achilles tendon attaches to the back of the heel, near the apophysis, and the plantar fascia attaches near the apophysis on the bottom of the heel. The significant pull between these two structures can irritate the softer material of the apophysis, resulting in calcaneal apophysitis or Sever’s disease. Repetitive motion and irritation of the heel apophysis does not affect the growth or outcome of the heel bone as an adult.