Have you tried just training through and eschewing all the treatments?

Some top Kenyan runners have terrible Achilles and just smash through their training regardless.

There is no corellation between tendinopathy and rupture either so you should be good to htfu.

I feel your pain...I have a bone spur in my heel and resulting tendonopathy. I have been through physical therapy, I've just tried running through it. Reading what others have done on this forum I am now 7 weeks into not running at all for 8 weeks. While it is less painful even just a brisk walk in downtown Detroit last week for an appointment flared it up a tad...maybe a three on a a ten scale. My doc says cutting the spur out will only cause it to grow back more quickly. At 60 years old I don't have time to waste on these things so my plans is to give it a full 10 weeks of rest...if it isn't better then plow through it this season and then see what goes from there.

I am, 60 as well. i will see what ortho says. i've been out since july so my plan is to start running again and doing things and living with the pain. i am into second week of second PRP injection so i am still in a boot. i will stay in the boot for a bit longer and start swimming. i'm tired of this and tired of throwing everything at it and having it fail. maybe voo doo. gonna try to live with the pain if i can.

i feel YOUR pain.

i am scared of the surgery as well though i know a bunch of professional runners have had achilles surgery and made it back. i worry about the rehab and complications. plus how much more down time will there be - another 9 months? yikes.

I ruptured my achilles end of May last year. Surgeon gave me the option of no surgery, but possible limitation of activity, or have the surgery and better chance of full activity. I opted for surgery (There's a thread here somewhere with a few pics). Surgery was beginning of June, and I was in various stages of casts/walking boot and non weight bearing for 8 weeks, a couple more weeks of walking in the boot and rubber band exercises, then able to full walk and therapy.

Somewhere in August I was allowed on the trainer (no outdoor cycling), and very early Oct. I was allowed to start running again. My PT and surgeon were top notch, and I was cleared for full activity (Except for some of my martial arts stuff) in early December. Did a 20k TT yesterday at 3.2 w/kg (168 lbs), and planning on running Ragnar del Sol in late Feb.

My personal thinking was that I wanted whatever option gave me the best chance to return to my normal list of activities, and to just deal with the lost time, and I don't regret that decision at all. I would recommend the same, pick whatever option gives you the best chance to return to full, pain free activity.

ETA: I'm 46, was 45 when I had the rupture. There was another guy doing the same rehab that was in your age range, and he seemed to be getting on pretty well.

John

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thanks devlin. sometimes i think a rupture is better than tendonosis. it's a clear cut decision basically -- don't they mostly always surgically repair ruptures?
i will see what surgeon says when i see him in february. i am hoping that if he feels surgery is necessary, maybe it won't be a complex one as maybe it is just cleaning it . no surgery is simple. what scares me is that it might be worse off post-surgery.

so my plan of action is to stay in the boot for another week post-PRP. then start swimming, pushing off the wall, doing my own PT - eccentrics, etc. and then see the ortho.
very very disheartening injury.
thansk again

this has being going on for only six months, which is a short time for achilles injuries..
Start with the reading and exercises here,
http://forum.slowtwitch.com/...ng=achilles;#4122076
continue here,
http://www.runnersworld.co.za/...10-laws-of-injuries/

then consider your options in another six months..

He gave me the option. He said for "younger" athletes (I wanted to hit him) it's almost a mandatory surgery. My options were the surgery, or a pointed toe cast for a few weeks to let it kind of grow back on its own, and then gradually recasting at increasing stretch. The second option might not allow full movement, and since I also do martial arts, I wanted the best chance for full recovery. It does help that I've always been a really good healer (This is my third tendon repair, I cut tendons in my little finger in college), and I found a good surgeon (The surgical guy/group that does the Az Cardinals, Az Coyotes and a couple baseball teams). Made all the difference.

John

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Top notch coaching: Francois and Accelerate3 | Follow on Twitter: LifetimeAthlete |

doug ----
not sure what you are suggesting? i have done the eccentrics since july. the doctor who gave me the PRP injections told me they don't work for everyone.
i did them on my own, did them in PT. not one bit of change.

are you saying that there are many ways to treat this and you have to find the correct one?

You didn't want to hear from someone who had surgery for a ruptured AT but bear with me. I was on the tendonitis/tendonosis/tendonopathy roller coaster for about two years. In the beginning, I ran off and on through various treatments until I couldn't any longer, in fact walking became a painful limp (saw three sports med. doctor's and a podiatrist). I decided I wanted/needed achilles debridement surgery but my doctor at the time said "good luck finding a surgeon to do it; the complications from the surgery are too risky" followed by saying that I should hope that it just ruptures (WTF!!!). This doctor also wanted to do PRP and I left the office pretty discouraged....

Not long after that visit, I was walking up stairs at home to go to bed and I collapsed on the first step. Hurt like a SOB but I was used to pain and off to bed I went. Woke up to a swollen ankle and obvious gap where my achilles should be. Had emergency surgery two days later and the ortho said that even though they normally don't operate on ruptures, mine would not have healed without the surgery and I was lucky to have enough healthly tissue left to get a good repair.

I am now thirteen weeks post op, swimming, water running, stationary cycling and resistance training. Still walking with a limp but getting better and stronger every week. I now have more hope than I've had in two years that I will be back to running eventually.

Good luck with your injury!

thanks comfort zone.
that's not very encouraging. i know what you're saying - a rupture has a definitive treatment and end point. i didn't think a debridement was that big a surgery or had so many risks. thanks for letting me know. my first ortho said i had more healthy tissue than not so that is why i worry about having surgery - he suggested trying all conservative treatments - hence the two PRP injections. i doubt my achilles will rupture - you i guess was lucky.

i'm at a loss.
thanks.

I think the risks are about the same for the debridement and AT repair. I found lots of good info on this site: achillesblog.com

I'm saying six months is barely enough time to heal a chronic achilles problem, so your expectations are unrealistic. That's six months of healing time, not six months of slamming the injury with fifteen different treatments.. injury at our age is a long haul to recovery, not a quick visit to the surgeon. A surgeon operates, that's his job, so it's likely he will recommend surgery. The operation can be effective but personally I don't like getting cut, so would take the conservative approach for at least another six months.

It's odd the eccentric work had no effect, typically that is very effective. There's something else going on - read the ten laws and figure out the history of the injury..

I'm in a similar spot. Achilles tendinosis. Became painful to run and no longer pliable during the slow winter months after a Fall 2011 ironman. I was unresponsive to months of PT, which was mostly Graston, some ART and eccentric loading. 2012 became a do nothing year and I stopped most training.

I'm now about 2 months after the first round of PRP. Medically cleared to do everything except run. But the injury is still not responding so far. I'm continuing with PT; more Graston, ART and eccentric work to see if that, along with PRP, addresses the injury and visible bulb of scar tissue. Doing this for 6 more weeks, then moving up to ESWT shockwave therapy.

Too much can go wrong with surgery at any age to not try everything else.

I had my first workout in 6 months this morning. On the elliptical. It was pathetic.

Not to hijack the thread - but Comfort Zone, I too had my achilles rupture just about 2 years ago now. I had surgery, had the cast, then the boot, then back to no boot and walking with crutches. I took it very easy for about 2-3 months. I then went on the trainer inside for about 6 weeks combined with PT and then started running (well jogging at best - 13 minute mile my first one). I ran on the track for the first couple months, much safer than landing on something random and messing it up.

You just need to be patient and careful, I am happy to say I am back and a little over a year later I ran my first half marathon. Now 2 years out I am signing up for another 70.3 this year.

To the OP - whatever route you take will take time, the achilles area has poor blood flow and so everything heals slowly. Be patient, cross train whatever way you can for now and you will get through it. Best of luck!

wow. i totally did not respond to the first PRP. my doctor's protocol was one week in boot, 2nd week wean myself off of the boot and start swimming, third week do whatever i wanted. i stayed in the boot for 2 weeks and started swimming after 3rd week. absolutely no relief in the pain. after 6 weeks of just swimming i still had achilles pain. i decided to try a second go of PRP - 10 days in now. i just don't know if it will work - have taken boot off to walk around the house and the same achilles issues are still there. so i will wait and see what happens. i agree with not having surgery but i am starting to run out of alternatives. the EWST treatments are also not covered by insurance and pretty expensive. i have read about topaz treatment but i think that is considered surgery as well.

did your achilles hurt on the elliptical this morning?

Yes, my achilles was uncomfortable on the elliptical. About 4/10 or 5/10 on a perceived pain scale. So used to low levels of pain that this is normal these days. Perhaps if I spent more time getting loose and warmed up, that number would drop. Note that after PRP, there is much more discomfort and pain in that area than before the procedure. I suspect it's the slow recovery from 6 injections with a 20 gauge needle. The platelets, too.

I followed the same protocol with 2 weeks in the boot, which was awful. Walked a lot. Wore the boot sole down to the plastic.

I found that before PRP, on my bike trainer, I could spin without any trouble. But if I pushed hard, the pain would surge. Basically it's at anytime of maxiumum tension, which is when my toes push hard off the pedal, or anytime off the ground.

And you're right. The procedures are not covered by insurance. Altought the blood drawing in the office lab and the boot were covered under different CPT codes. For anyone reading, my PRP procedure was $500. I did it at the end of 2012 and did not have any FSA funds left, either. ESWT will be a lot more.

Good luck in your on-going treatment and recovery!

There are several relatively new minimally invasive options for tendinosis debridement (still surgery) rather than traditional open surgical debridement. Here are a couple that you can discuss with your treating physician if he/she performs. Best of luck

The Tenex FAST procedure:
http://www.tenexhealth.com/fast-procedure/procedure-overview/


Topaz procedure:
http://www.topazinfo.com/patient.aspx?pid=41

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Fatigue is biochemical, not biomechanical.
- Andrew Coggan, PhD

Thanks Leder, that's great to hear! It's such a 'pick me up' to hear that you had the same surgery and now you are running and back to doing tri's. I'm being very vigilant with my PT and patience is my new mantra. It must have been a bit tough psychologically to start running again (hence starting on the track). I'm still in the 'paranoid to re-rupture' stage and walking the fine line between stimulating the tendon to get stronger and letting it heal. I would love to get back to racing too but honestly I'll be thrilled to run a 13 min mile some day! Best of luck to you in your training and racing.

I really can't believe that someone would say "train through it". I tried that during several bouts of achilles pain. Usual stuff, sore in the morning, running lunchtime or after was ok etc etc. I then had no option but surgery. Got a great surgeon with a poor bedside manner and I never got the advice I needed which was to get the tendon moving again soon as to prevent scarring. So I kept it immobile and yep I ended up with a second op. But if the post op advice is good and you really stick to strengthening exercises all will be ok. Hope this helps

Had a large bone spur which was protruding into the achilles surgically removed (chiselled out) and the achilles scraped in December of 2000. Walked back into my follow up appointment 2 weeks later. Started walk/jogging a week after that. Was on the track hammering out 400m repeats in March of 2001. Could probably do with another surgery again now, but I don't need to run as much or fast anymore and just get by with managing the pain which seems to set in once I get up over about 40-50 miles/week or do anything relatively fast.

Good Luck with it.

WaySub4...so no recurrence of the spur? or if so how long has it taken to come back? my doc said it would tend to come back sooner rather than later but if you're talking 10 years and I'm 60...seems to me to be a good option.

Achilles are slow healing. Also, there have been studies showing that PRP is not all that it is being claimed to be. This article cites one study that showed no difference between placebo group and PRP group when treating Achilles tendinopathy.

John

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Top notch coaching: Francois and Accelerate3 | Follow on Twitter: LifetimeAthlete |

I ran pain free for 3-4 years after the surgery at a high level with a lot of volume (100+miles/week and fast running). I then didn't run a step for 2 years to work on my golf game and put on 20lbs. Since I've returned to running and this triathlon business, I definately do have some pain in the achilles if I try to go fast or do significant mileage. This could very well be from a recurrence of the the spur, but it has yet to bother me enough to go see a doctor about another surgery. So I wouldn't say it came back 'quickly' if it is indeed the spur again... I had a good few years in there with no pain at all. If my pain worsens again to the point where I can't run enough to do tris at the level I want to, then I wouldn't hesitate to get the surgery again.