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Achilles tendonitis is going to be on the back of the heel and when you see this, you really should think of another cause, particularly spondyloarthropathies, fluoroquinolones antibiotics which are commonly used for urinary tract infections - at our hospital now the fluoroquinolones are first line for community acquired pneumonia. I guess they are just less expensive and easier to give, but it’s not cheap Cipro. I guess it’s Levaquin, seems to work pretty well for upper respiratory-type infections and it’s just easier than giving a combination of erythromycin and cephalosporin. But these antibiotics have been associated with Achilles tendonitis, among other tendonopathies, and it can occur very quickly and these patients can actually go on to rupture. So if you have a patient on a fluoroquinolone and they develop a tendonopathy, probably get them onto another antibiotic. Particularly Achilles tendonopathy. The amount of stress that is on that, it just may pop.
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That’s why we have a field of podiatry because these problems are very very common. One of the areas, the plantar fascia, can be involved with plantar fasciitis as it inserts into the calcaneus and also the Achilles tendon as it inserts into the back of the calcaneus. These are very common problems. If there is any sense that it is chronic inflammatory in nature and there are other systems involved, really think of a spondyloarthropathy because these areas are very commonly involved with things like ankylosing spondylitis and the like. But I do see patients occasionally and that’s all they have. They just have Achilles tendonitis or plantar fasciitis. Sometimes you can even get bursal inflammation although it’s very difficult to differentiate from direct tendon involvement. But plantar fasciitis, again the most common situation I see is someone who walks a lot. Mail carriers. They start out with a 50 pound bag of mail and it’s hard on their feet. They just walk around and deliver mail all day. But anybody who is on their feet a lot, walking, carrying extra weight, and the pain is usually in the sort of medial aspect of the bottom of the calcaneus. It’s not dead center, because that’s not where the plantar fascia inserts.
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When you examine you can put a stress on the plantar fascia either by pushing on the forefoot up, or just putting your thumb right into this area of the insertion. It will usually be tender.