PT on the Net Research

Skier’s Achilles Tendonitis


Question

I am a Ski Teacher / Racer in the winter seasons and I am constantly getting Achilles tendonitis and tendonitis of both my lower legs by my shin due to the inversion of my feet I think. It is becoming far too regular for my liking. If you could assist me with any information on prevention, cure or treatability I would be most grateful.

Answer

If in fact your symptoms are most likely due to your ankle pronating. The “quick” solution would be to have your feet evaluated by a podiatrist. The podiatrist may then prescribe custom foot orthotics for your ski boots and every day shoes.

However, most injuries like yours are not isolated to one part of the body, even if the symptoms are. The fact that the inflammation or “itis” has manifested itself in your lower leg may be a result of overload of the muscles of your shin. This overload would be accompanied by a continuous stretch on the calf muscles and Achilles tendon while in your ski boots. The muscles on the front of your shin (the anterior compartment) are anchored on your foot and shin. Those muscles in cooperation with the design of the boot place your lower leg on an angle toward your foot and cause your knee to bend.

If you pronate a lot in your boots, your anterior compartment will be working to try to minimize the transfer of your body weight toward the inside of the ski. So if you are in your boots, those sore muscles are “firing” almost constantly to fine-tune where your body weight distribution is.

I say “fine-tune” because all major adjustments for your body weight distribution occur at the area of the hips and pelvis. A simple exercise to observe the interaction of the hip and lower leg muscles is the single leg stance.

Stand barefoot in front of a mirror in short pants. Stand on one leg. Observe the leg you are standing on. The goal is to keep the arch up on the stance foot and the knee cap pointing straight ahead. If you pronate a lot, the odds are you arch will immediately flatten and your knee will turn in toward the center of your body. This can be avoided by good neuromuscular control of your glute and deep rotators of the hip. This exercises should be done while keeping your torso straight up and down over the pelvis.

The off-season is the ideal time for you to be working on addressing your kinetic chain for injury prevention. If you are able to master the exercise described above, progress to doing it on a soft pillow. Once you feel you are able to achieve the neutral position desired, you are ready to move on to unstable surfaces for your leg work. This can include devices like wobble boards, air disks and half foam rollers. The desired outcome is to strengthen the entire lower extremity as an integrated unit WITHOUT reinforcing poor motor habits that your body is accustomed to.