[Closed] Achilles Tweak...

Wait and speak to the physio.

Don’t over stretch until you have seen them.

You could get a sleeping brace thing, but again speak to the physio first.

I've struggled with insertional achilles issues for some while (over 10 years), and after many different medical professionals each giving differing advice - I now manage it reasonably well (by feel and experience). If yours is insertional it would be worth getting a scan for underlying mechanical issues (such as a haglund deformity/bone spur).

Regardless, the general school of thought to longer term management seems to focus around both flexibility (all round, not just localised...I started doing yoga) - and strengthening all the structures around the achilles. Calf strengthening has helped mine a lot. Machines in the gym, weighted eccentric heel drops, weighted tip toe walks, bounding.

I'm no physio....but this has helped mine considerably.

You could get a sleeping brace thing

- a night splint. Mine was very uncomfortable.

Also...for repair, if you have reasonably deep pockets or medical insurance ESWT shockwave therapy is definitely worth a shout.

Unfortunately you are probably going to require a lot of rest, stretching and massage to loosen then strengthen it.

Having said that (and snapping one clean in half in a crash) I’d be inclined to listen to what the professionals say after examining you.

And if you’re not happy with the assessment, have a dig about on the web for a more specific practitioner who is recommended etc.

industrial qts of Naproxen

Anti-inflamatories slow healing as inflamation is part of the healing process. The inflamation increases blood flow in the area etc. Tendons heal very slowly as they have very little blood flow. Most Physios / Sports therapists now recommend not taking them.

I’ve struggled with insertional achilles issues for some while (over 10 years), and after many different medical professionals each giving differing advice – I now manage it reasonably well (by feel and experience). If yours is insertional it would be worth getting a scan for underlying mechanical issues (such as a haglund deformity/bone spur).

Insertional achilles tendonitis has ****ed me since 2016, and I had surgery for Haglund's in January. Got the op on the other foot to look forward to next year, and I'm still in the relatively early stages of recovery from the first.

In short, keep your fingers crossed its not that, because its an absolute sh*tter.

Mine has been sore for years and I hobble down the stairs every morning. I’ve tried the boot at night thing. It’s clearly linked to a complete lack of flexibility in my case and I need to work on the hip on that side first.
My tendons and ligaments appear to have turned into old leather belts over the last few years. There is no stretch left.

Ice and active rest. Unless it is very painful when moving around try to move it as much as possible.

As above avoid NSAIDS for now and dont stretch. It does nothing for any injury but Achilles injuries can be made worse by doing it.

I dont suffer now (because my training is so light) but when I did I found (with a small number of exceptions over the years) that it was an injury that with care you could train through. Pain should be your guide but I found that after warming up it often didn't worsen during the session and in spite of continuing to train it still cleared up after a while, icing at least twice a day I found helpful. Yours may be different and I wish you luck but the comment above shows that seeing a professional doesn't always provide a good answer.

Managed to pull both of mine walking too far too fast, after shoulder surgery stopped me running. Turned out to be where the Soleus meets the tendon, so the classic tendon stretch did nothing and I have to do bent knee stretches which are horrible. The point being I would have never worked that out myself as the pain refers all over the place, see a professional to diagnose it correctly.

Good advice on the NSAID's ta. I'm probly a bit old skool so go at 'till it hurts then gobble the Brufen/Naproxen.

So, I'll not stretch it but will keep mobile (not sure what 'active rest' is? ). And I'll lay off the NSAID's as, I thought the anti inflam part was a good thing but happy to keep off them as it doesn't hurt that much whilst slobbing around.

I'm also elevating whilst sitting. Is the compression bit of RICE useful in this sort of case please?

I have some history on the bone spur issue, if that is the case just stop until you have had a scan. I am in month 8 of recovery after having it lopped off.
I hope its not that.
Go see a proper person I had years of stretching off a step pre scan then got "do not do this, the bone is cutting into the achillesand the producing more scar tissue than achilles"
Good luck

@boobs, was it a calcaneal osteotomy you had?

How's it feel now? How much strength have you got back? I'm in month four...

When mine went the physio suggested lots of slow calf raises and lowers over a step. 15 seconds for each lower so really slow and then faster back up.

Do repeats if that along with lots of rest.

Sorted mine.

Sounds like you might need to give it a little rest right now, but once it's feeling less sore think about some pilates to flex and loosen everything up from plantar fascia in the foot, achilles and calf then hams and hip flexors and glutes, lower back. I had some real achilles problems returning to squash a few years ago and after a few months of pilates it was sorted.
Bent knee calf raises are good for targeting the soleus in addition to your straight knee calf raises. Might want to check your saddle height as well in case that is overstretching slightly.

I had Achilles issues and went to:

PT
Osteo
Physio x 2
Movement specialist

Just panicked and thrown money at it to try and solve.

Recommend making sure there are no complicating factors like ankles / hips / groin / hamstring that are contributing to it and working on overall flexibility. All the above argue over the best way to solve, if they say round a table while looking at you it would be really helpful.

Combo of:

* Walking barefoot on grass / sand
* Ankle mobilisation
* Using mini roller on sole of foot
* Make sure glute activation is efficient on walking / running / cycling

On to:
* Double heel raises standard / bent to sort both muscles in calf > weighted > single eccentric drops.

* Strengthening hamstrings / hips

* jumping in water.

It’s a beeeiiiitch. Hope you manage to sort it.

Don’t go into any yoga / Pilates unless the teacher has good detail of your issues and can work to actively help / avoid further injury. Avoid random stretches over controlled movement and building strength.

If you are comfortable with physio do the exercises / rehab religiously. If your overweight drop some and make sure to cut back on food if your diet is based on pre-injury training load.

At least you have timing on your side. Sun and warmth def helped me sort.

I had a tendon debridement with an Entesophyte and Hagland excision then reattachment with a speed brace.
I'm 6 months in and have started an old man jogging program, I can bike ok but am only on week 2 of the running.
It aches a lot but is getting better.
I have been "the perfect" rehab patient apparently? I guess this means I want to get better.
Strength is fine stopping and starting again is the problem.
Hope yours is doing well.

the comment above shows that seeing a professional doesn’t always provide

Indeed. I saw a physio and a podiatrist. I’m not an expert on this stuff

@boobs thanks for the info. I have had that op booked, then pulled out last minute as couldn't bear the thought of being off my feet for 6 months. I think because it is elective surgery rather than "mandatory", and I can still function (albeit not as much running as previously).

I was also offered a calceneal osteotomy (Zadek) where they don't detach the achilles, but rotate the heel forward. and then bolt it together again. Oddly that didn't appeal either.

A colleague of mine has had minimal surgery - just to knock the haglund out without and detachment. Which I think if offered to me, would probably appeal more.

@finbar - which option did you plump for?

Nice one @boobs, I'm glad your rehab is going as well as can be expected it sounds like.

@mccraque, I had the calcaneal osteotomy, which as you say leaves the tendon attached (and the Haglunds lump in place), but cuts a 'cheese wedge' of bone out of the middle of your heal and screws it back together again, thus cranking the lump out of the way.

I had the op on Jan 25th. I had a full six weeks non weight bearing in a cast, then two weeks transitioning out of it, and baby steps of progress ever since then. I can go on the turbo now for a good 45min and run up the stairs etc., but I've not actually tried a proper jog yet - my physio will get me doing that in June.

Still hurts like hell if I overdo it, e.g. I had to do a long (6h) drive last weekend. On the plus side my heel looks much more normal now 🙂

I'm not sure how surgery to remove the Haglund's without detaching the tendon would work, but I'm no expert and I definitely agree that sounds like the best option if it's possible.

not sure how surgery to remove the Haglund’s without detaching the tendon would work, but I’m no expert and I definitely agree that sounds like the best option if it’s possible.

They can go in from the side and knock it out...but I think it depends on how far down the line you are already. If it is caught early, this is a much quicker recovery. But my surgeon said "there's too much going on in there" when considering that option for me. I think inflammation, calcification.

I have to say a year of not wearing work shoes and wandering the streets in Nike Free trainers with no heel cup has really helped me manage mine non surgically. For the moment. It hurts more in the winter!

Do you lot mind, this is 'achilles inflation'. I come here with a tweak and now it's all bone saws and Scandahooligan names for stuff that needs cutting off.

'2 paracetamol and a lie down' was the feedback I was looking for... 😕

Just in case: 😁

*sorry* 😀 ! As you were, I'm sure yours will be fine this time next month 🙂

haha. Sorry. We digress!

But - I guess if anything is to be taken from the above it's not not ignore it. I made the mistake of running through mine. The pain was never that bad and it went after I started running. Returning a few hours after. A very gradual progression over many years later and we are talking osteotomy and debridement.

The 'running through it' ship has sailed. It started 30 miles into a 130 mile ride and *really* hurt at the end. I've been RICEing for a couple of days plus inhaling chocolate etc as my body obv suspects an imminent return to Defcon 3 levels of spanking.

Physio tomorrow so we'll see. Spoke to him today as I couldn't get in in person and he conveniently suggested I do what I'm doing (sans extreme calories).

So reporting back...

Physio today suggests it's combo of Paratenonitis and inflammation of the Posterior Tib tendon - through overuse...

So free to apply more peas and RIDE but low mileage/low resistance/high cadence and NO impact (running) training - boo!

The swelling has mostly gone after 3 days which is good as cankles are not a good look 🙃 Pain is none existant when stationary and only really appears when I initially start to move again.

Shortish spin tomoz to test the theory 👍

Well good news on the diagnosis, bad news on being a Tendon problem as they can take a very long time to heal. They need load to heal but only at modest levels. Overdoing it is the main risk.

Aye Ben, that's more or less what the Physio said. However, when he suggested short high cadence rides, my immediate question was 'how many per day?'...

I'll obviously need to throttle it back for a bit 🙄

Full circle on this...

I rode the 200 last weekend then another 270 back to the start over 3 days. I'm running at 90-100 cadence rather than my usual 80-90 and no standing/honking to try and keep the load down.

The tendon area is still sore when I've been inactive for a bit then move but it's not inflamed and doesn't hurt when cycling as above. No running for 4 weeks now as that really caused a reaction after an exploratory treadmill waddle...

I'll keep going on the spinning but will drop the mileage a bit now and keep off the running for a few more weeks. Oh, and I've knocked the Physio on the head as it didn't seem to be adding a lot.

Ben had it right, tendons take bloody ages but at least it didn't bugger up the event.

I will read this later but after reading just the OP.

Keep it mobile and let pain be your guide. IME Achilles injuries are one of the only areas where you can be in "discomfort" but the injury is still healing. Where that point is for you is guesswork.

1: Don't take NSAID's they are not helpful and may make it worse.
2: Don't stretch it further than your normal range and I would say don't do any stretching exercises at all. It is a myth and if you do believe in it fine but I would suggest never doing it for Achilles. Stretching is useless but harmless (but does feel good) but for Achilles I think it may make the problem worse (you cant actually stretch them anyway....)
3: Ice is your friend and provides a lot of relief just make sure you dont overdoe it and get frostbite.
4: Focus on building strength around it, calf raises, then with weight etc. Tip toe walking then bounding when you are ready. Calf rollers etc will help

You may find you can live with a small amount of pain/tenderness and get back to full training. I know a few runners who were plagued almost their whole careers and it had to be "managed" rather than cured. For others it may disappear totally. Hope your the latter.