Location Amsterdam
van Hallstraat 617
Location Ouderkerk
Holendrechterweg 21B

Achillespees Bursitis

As you can read in the general blog over achillespees klachten te lezen is, zijn er verschillende soorten achillespees klachten. Dit artikel gaat alleen over de Bursitis achillespees klachten. Het is belangrijk om onderscheid te maken met andere types achillespeesklachten omdat de behandeling anders is!

Wat is Bursitis?

Bursitis is een irritatie/ontsteking van een slijmbeurs. In dit blog gaat het over de 2 verschillende slijmbeursen namelijk de Retrocalcaneal- en de superficial slijmbeurs.(zie afbeelding 1)

Figure 1
  1. De Retrocalcaneal slijmbeurs ligt tussen het hielbot en de achillespees.
  2. De superficial slijmbeurs ligt tussen de achillespees en de huid.

Symptoms

  • Pijn rond de hiel net boven het hielbot.
  • Roodheid, zwelling warmte rond de hiel.
  • Drukpijn rond de hiel.
  • Pijn bij beginnen van sport of meteen na het opstaan in de ochtend.

Test jezelf 

Door de huid op het hielbot bij elkaar te knijpen met je duim en wijsvinger kan je testen of de superficial slijmbeurs de klachten geeft.

Door de net achter de achillespees te knijpen bij de aanhechting test je de Retrocalcaneal slijmbeurs.

Deze testen zijn niet perfect en het is altijd aan te raden om langs een specialist te gaan om dit te controleren.

Voorkom compressie

In het geval van slijmbeursklachten is het belangrijk om compressie te voorkomen. Om de compressie te verminderen is het belangrijk om de enkel niet verder dan 90graden te buigen (tenen naar je toe). Vermijd bijvoorbeeld heuvelop lopen of de heeldrop oefeningen.

Do not use shoes where the heel is very tight and therefore exerts pressure on the attachment of your Achilles tendon. Shoes with a higher heel may help to reduce the pressure, you can also use a heel enhancement.

And perhaps most importantly, do not stretch the calf muscles! Stretching the calf muscles causes compression and can make the symptoms worse!

Wat kan je wel doen?

Stap 1 Isometrische oefeningen

To reduce the pain and control the tensile forces, it is important to perform the following two exercises.

Exercise 1: Isometric M. Soleus holds

Execution: Stand on the toes, bend the knees to about 90 degrees and hold this position for 15 seconds. Then slowly come back to the ground with the whole foot.
Reps: 3 × 10 repetitions per side.

Exercise 2: Isometric M. Gasctrocnemius holds

Execution: Stand on the toes, keep the knees extended and hold this position for 15 seconds. Then slowly come back to the ground with the whole foot.
Reps: 3 × 10 repetitions per side.

Stap 2 Kracht verbeteren

When the pain is gone and the symptoms are gone, you can start training the strength of the calf muscles. Calfraises are the right exercises for this. You must do this exercise with both straight and bent knees. Below the explanation of the exercise:

Exercise 1: Heelraise stretched knee

Execution: Stand on one leg. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.

Exercise 2: Heelraise bent knee

Execution: Stand on one leg with bent knee. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.

During this exercise the complaints should not increase, if this is the case the exercise is still too heavy for that moment. What is important in exercise 2 heeled knee is that you do not get an increase in the symptoms. If this is the case, you should bend the knee less. For example, start with 10 to 15 degrees of knee flexion and build it to 25 degrees.

Stap 3 Hardlopen!

Figure 2

Now you start running again! It is important that you start up quietly, ask for help from your therapist. Make sure that everything you do is virtually pain-free. It may be that you get some sensitivity during the build-up, as long as it is a maximum of 4 on a scale of 0 to 10 you do not have to worry about it. If the complaints then go away again. See figure 2 as an example.

Besides starting to walk, it is important to do the following exercises.

Exercise 1: Triple extention

Execution: Stand on one leg with bent knee, bend your torso slightly forward. Now stand checked on the toes while simultaneously stretching your knee and hip. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.

Exercise 2: Calfraise stretched knee with resistance

Execution: Stand on one leg. Put a large resistance band around your feet and your shoulders. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.

Exercise 3: Heelraise bent knee with resistance

Execution: Stand on one leg with bent knee. Put a large resistance band around the feet and shoulders. Now stand on the toes in a controlled manner. As soon as you have reached the highest point, you will return slowly until your whole foot is on the ground.
Reps: 3 × 10 repetitions per side.