I have no direct experience with stem cell injection/implantation to either acute or chronic tendon injuries. Much more expensive than just PRP (you can do stem/mesenchymal and PRP together) and even then rarely covered by most insurance payors.

My experience (over the past 3-4 years) with PRP inj for chronic tendonopathies varies. Anecdotally not as good as I would like (nor what is reported on the web it appears), however there are really no side effects other then cost and possibly low efficacy.

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

thank you for your objective insight. as you indicated, insurance will not cover the cost and as a result, I am on the fence. In your experiences, would ESWT (high- or low- level) be a better avenue to pursue since I will be out of pocket on this endeavor?

I have had even LESS success with ESWT for achilles tendonopathy (and plantar fasciitis) and have never used it for peroneal tendonopathy. This was the rage about 10+ years ago, but has slowed to a trickle now. I don't use this any longer, though the good, high power machines (most from Germany like the original Ossatron) have some limited usage. Certainly useful for kidney stones! Used to be a covered treatment, but now also mostly dropped since very low efficacy with several studies to back up the low efficacy. Again, no side effects, and I think current physicians who still do this are likely doing this in-office and "for the $" only.

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

thanks again for your consistent productive contribution to this ST forum. have a great weekend.

Sgate (or anyone else in the group whose dealing with this), how are you doing now? Did you get better? How long did it take?

Was physical therapy painful?

I've been wearing a CAM walking boot for about 2 months now for peroneal tendonitis. When I started wearing it I was in constant pain so bad that it was hard to sleep. Now it's a much duller pain now (but the pain is still there even when I'm resting). I've read conflicting things about whether or not physical therapy is supposed to be painful. And if it's going to hurt how much? Thus far it has PT has usually been bearable during the sessions but gets worse in the hours shortly there after. I understand that "no pain no gain" concept. I just want to know what I'm supposed to do and except from someone who has gone through it.

All of this started for me about 5 months back after tripping and spraining my foot. I'm SO SO over it and want to get back to my healthy and healed life.

Physical therapy was not painful at all for me, but I had very dull pain in general the entire time except in the first few weeks after the initial injury.

I am just now back to running maybe 75% of my pre-injury distances and pace. Although my work-life balance has been partly responsible for that. The tendon still hurts from time to time but it hasn't slowed me down or made me skip any runs yet. Ironically, it still bothers me when cycling. Am wondering now if my shoe/cleat fit is off as it tends to hurt less with my old shoes and cleats.

So long story short, I would say I'm not 100% back to normal but its not limiting my activity at this point. That doesn't mean I'll be able to get back to Ironman distances without it limiting me, but its been slow steady progress so I'm optimistic if I don't push too hard I can get back there. I would strongly encourage you to get out of the boot if you are still in it. 2 months is a long time to be in a boot and can cause other ankle problems (it did for me).

Your experience sound somewhat similar to mine, although maybe a bit more pain. I assume you had scans to rule out any tears? If your experience is like mine, you're in for a long haul. I wish I had just accepted that at the outset and used the time off of cycling and running to do more swimming or lifting.

Thanks so much sgate for getting back to me. It helps so much to understand what to expect.

What sort of complications did you have from wearing the boot? I'll make sure and bring it up with my doctor.

I had two MRIs done a several months back with conflicting results. One said a partial tear anterior talofibular ligament the other said I had posterior tibial tenosynovitis (but no tears). But the pain is by the peroneal (behind my ankle and coming up my leg). My new doctor has me scheduled to do another MRI on a better machine to see what's going on now.

Fingers crossed I'm on my way to recovery!

Thanks again!

sgate, just saw the issues caused by the CAM boot... noted.