One of the biggest recent sports stories involved then-Golden State Warrior Kevin Durant. In game five of the NBA Finals, Kevin went down with an Achilles tendon injury.1 The interesting situation here is that Durant had also been nursing a calf injury for the previous few weeks that actually kept him out of the first four games of the NBA Finals. It was hard watching him fall to the ground, clutching his right Achilles and calf area with his hands. He limped off the court assisted, and was ultimately diagnosed with a ruptured Achilles tendon and underwent surgery.
As people looked for answers to what had happened, Bob Meyers, president of basketball operations for the Warriors, spoke at a press conference after the game. He stated: "The initial injury was a calf injury. This is not a calf injury." Myers said, "I'm not a doctor, I don't know how those are related or not, but it's a different injury."2
This is a great opportunity to discuss the general public's lack of knowledge of lower extremity anatomy, biomechanics, movement patterns and how they are all related. One of the most frustrating things for me in active practice is how little education our patients are given about their own bodies, including the feet, ankles, legs and knees. It's time to break down the Achilles tendon and calf relationship, as almost all health care providers deal with this area frequently in clinical practice.
Anatomy 101: The Calf, Achilles and How Overpronation Relates
The calf is often referred to as sura, which is the Latin word. It is the back portion or posterior compartment of the leg. The two largest muscles (the gastrocnemius and soleus) are known together as the calf muscles and they both attach to the calcaneus bone via the Achilles tendon.3
Understanding the anatomy of the calf is pretty simple, but let's complicate things a bit. If you recall, we all have three functional arches on the bottom of each foot: the medial longitudinal arch, the lateral longitudinal arch and the transverse (metatarsal) arch. These three arches form the plantar vault and are the basis for stability of the human foot.
The arches are formed by the plantar fascia and the bone-to-bone ligaments (like the spring ligament). When the arches are working well, the foot is allowed to move fluidly into regular pronation, regular supination and proper weight-bearing during standing and the gait cycle.
Up to 99 percent of the population display excessive pronation – their arches flatten out too much and fall toward the ground.4 Because this phenomenon happens so frequently in the patients who come to us for care, it is easy to see daily.
When the feet are overpronating, the three arches drop more than they should. As the foot falls to the ground, the tibia bone must inwardly rotate as a compensatory mechanism. The inward rotation of the tibia then causes the femur to rotate inward (medially) as well.
The excessive pronation has now set up a biomechanical situation whereby the dropping of the arches and inward rotation of both the tibia and femur bones stress the inner ankles and knees. As one of the consequences, the gastrocnemius and soleus muscles overcontract, even at rest.
Muscles that are essentially getting overworked are very susceptible to injury and damage. We can see this damage range from a calf strain or pulled leg muscle all the way to Achilles tendonitis, Achilles tendon tears or complete ruptures.
It's not just that the gastrocnemius, soleus and Achilles tendons are located too close to one another. The physical relationship is compromised by the biomechanical fact that excessive foot pronation can and will negatively affect the forces coming up from the heel and ankle into the Achilles tendon and calf. This relationship is what most people don't understand.
When an Achilles Tendon / Calf Injury Presents, What Can You Do?
So the question arises: What can I do in my clinic when an Achilles tendon / calf injury patient presents? Here are some smart options.
Evaluating Pronation Is the Key
You may never see a patient / athlete the caliber of Kevin Durant, but your patients deserve to be treated like they are superstars. Please take the time to look at their feet, ascertain their pronation degree and treat them properly. Foot support is key or else the overpronation pattern will continue, stressing the ankle, knee and all muscles located in that area. Plus, your adjustments of the ankle and knee will never truly hold unless the three arches are supported properly.
References
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
