This is not likely indicative of poor circulation. Do you have any other reason to suspect circulation issues besides that?

It's true that the tendons take longer to repair in part because of their reduced vascular potential.

But, you may be grasping at straws because you are desperate to get back to running and never miss time again. There are too many unknowns to blame your relapse on poor circulation. Everyone has that same physical issue. Even with 'less' circulation in the tendon than the next guy, you have more than enough to have healthy tendons. Besides, it's the hand that you are dealt. So, it's going to take a ton of patience on your part to be able to come back slowly and then become very strategic with your running patterns to baby your progress upwards. It might not be the time table that you would draw up in your mind. It should be dictated by what your body can handle.

I won't go much deeper than that because seeking med advice on a forum has to be taken with a grain of salt unless you know those posting.

You may also look at how you structure your training runs, intensities, recovery from those runs, stuff like that. Also, I've had some injury relapses before because I would come back thinking I had been conservative but, in reality, it was still too aggressive. I was shocked to find out what I thought was short and easy was still way too long and hard.

And, I have to add...if I had to put a finger on something, I'd bet more on a tendency to do things like going for 6 mile run over who knows what terrain at who knows what effort on 2 hrs sleep and jetlagged and stressed from life & work. We all live in a 'Get What You Can When You Can' training world, but you have to understand that you can't separate stresses from sport and life. You might be surprised to find out that you could run just as well, if not better, with staying in tune with your own self awareness and knowing when not to run as much as when to get those miles in.

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"Outwork your talent." Kevin McHale

Not a doc, but I like to foam roll before I run, especially long runs, to help get blood flowing. It could also be a lack of strength in your stabilizer muscles.

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Strava

I have exactly the same two problems. Poor circulation in my fingers and feet and plenty of achilles problems. I've often wondered if the two were at least partly related.

I've tried the whole rolling/massaging your legs thing. Barely helps me at all.

In winter its the worst. I start off a run with no blood flowing down in my lower extremities at all (not really but that's how it feels) and my achilles problems are definitely worse. It doesn't help that I'm often trying to do high mileage in the winter. Wake up on a week day after having run doubles the two days before and your legs are going to feel stiff, no matter how fit you are.

In the summer its much better, regardless of mileage levels.


A long time ago I was puzzling over a better way to get my lower legs warmed up and remembered how good it feels after taking a long hot shower. I didn't see myself doing that every morning so I tried the next best thing.

Try this.

1. Find a little cooler. Not huge, just big enough for you to put both feet in up to the calves. Like those 16-quart ones the super market sells.
2. Fill it with water as hot as you can tolerate.***
3. Sit down and put both lower legs into it and sit for about 15 minutes. I will turn on the TV and do it on the couch.

Your body reacts to the hot water by trying to cool you down. It floods the entire area with blood. After 15 minutes, your legs will feel super loose and ready to go.

This has been a life saver for me. Best part of all is you can be lazy. No need to massage/roll. Just sit there and let the warming happen.

***When I first try to put my legs in it, the water feels much too hot. I have to take my legs out a couple of times. But it's not really too hot, it's just that my legs are so numb and starved of blood it feels that way. After a couple of tries, my legs get used to it. But if you choose water cool enough to put your legs in it right away, it's probably not warm enough.

Doubtful is a circulation problem.

Do you pronate? Have you had your feet x-rayed to check their alignment from the anterior part of your ankles to your big toe? On an x-ray if you can draw a straight line from the front of your ankles and it can't come out the end of your big toe you are probably over pronating. That cause the Achilles to "bend" and over time can cause tendonitis that you will never get over unless corrected because when you run you will cause the Achilles to move out of alignment (bend) with each step. Its common for stability running shoes NOT to fix this problem. Is this problem bilateral?

You've given me lots to think about. I'll check to see if i'm pronating and will probably see a podiatrist in the next few weeks.

I have only just started doing the hot water bath but not before i run...i'll try that as well.

Cheers.

According to this paper, there are a variety of intrinsic and extrinsic factors which are attributed to AT (Achilles tendinopathy) Link Managing and training the tendon to take load though has been, in my experience, the best way to encourage the healing and proper arrangement of the tendon fibers. There is a plethora of material on eccentric and concentric loading protocols to help with this condition. Good luck.

Scott

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i have poor circulation...my hands and feet are always cold, especially during stressful times. The day the injury came back was after a 10km run that i did on only 2 hours sleep due to a stressful trip and jet lag. I can't help but think that running with poor blood flow to my tendons nailed me this time.



I have Raynaud's Disease I have use gloves and toe covers when I ride below 60degrees

Just taking this part of what you said. What worked for me is the BarryP approach.

I used to try and get a reasonable run in as often as the tendon allowed. Which wasn't often. The alternative approach is to turn that on it's head and run often but only as far as to not let the load build up in the tendon.

I had to get over this idea of what I thought was a reasonable run. I felt silly going out to run for 15 minutes. But now I've been injury free for over a year (having had many years off) and can run a pretty normal training plan.

So it's still coming back slowly but the variable is the distance not the frequency.

In another thread someone said tendons don't like too much load but they also don't like too little load. So another way of seeing the BarryP approach is finding the Goldilocks regular run to be slowly encouraging the tendon. Don't push it into damage, don't let it atrophy, little and often. That may be very little for a long while.

While all the advise in this tread is good until any underlying medical conditions/anatomical structural problems are ruled out they will not help.

Bottom line...…..go to a ortho and get an x-ray first.

I tried physio

Can you elaborate? What exactly was the tx?

I've been to a few physiotherapists, one podiatrist, and a doctor.

Physiotherapist #1: since you have Achilles tendinitis AND pirofirmis issues (on occasion), you need to work on your core. You can still run but make sure you do these floor core exercises daily.

I tried these pretty much to a tee, daily, along with eccentric raises and running here and there but it wasn't getting better after a few months so i saw a podiatrist.

Podiatrist: you just need to tape it, like this (he shows me), then you should wear this heal insert. You'll be better in two weeks.

Did not get better and regretted the $200 i spent for a 30-minute consultation. Took 6 months off running and started slowly coming back running. Tendinitis was gone but ankles felt swollen and sore so booked a physio session.

Physiotherapist #2: You probably just need to stretch more. Stretch your calves and hamstrings. Let's sign up you up for weekly physio sessions.

Didn't stretch much (my bad) but took another month off instead of booking more physio sessions, then started running again very slowly. Walking 2, running 1 for 15min. Then Walking 2 and running 2min, etc. Starting feeling great but after a longer run a few months ago, I woke up next day with what felt like a fractured ankle. I could walk but was limping. Next few days both ankles starting feeling sore. Left ankle still feels odd. The morning stretch in bed hurts the left ankle like crazy...i have to bend my leg so the stretch doesn't make it down to my ankle. When i foam role my calf on that leg it stretches the calf muscle and pulls at the ankle and causes pain.

I now feel the tendinitis again (hurts slightly to pinch...albeit much higher on the tendon. However, unlike last year, I don't have any soreness pinching the lower tendon, so i don't think it's as severe as it was last time. I decided to go to a doctor to ask about the mysterious pain in left ankle. I can't even swim because kicking in the water hurts.

Doctor (about the mysterious left ankle pain): X-ray won't show anything so you should go to a podiatrist and get started on other scans (ie. bone scan, cat scan).

In the past week i feel the mysterious ankle pain is slowly getting better so I've been holding off seeing a podiatrist. This is the second time i've had mystery ankle pain. Four years ago i did a hard track work that i was unprepared for and the next day i woke up and had to be on crutches because it felt like i had a broken ankle despite no trauma. Massage therapist said i must have had a upper leg injury/inflammation because of the track workout that was causing the upper leg muscles to pull on the ankle...something like that. I think the mystery pain may be from a rock climbing injury i had about 10 years that I had arthroscopy for.

I'll try BarryP when i'm ready again.
i'll get a gait analysis done.
I'll keep doing eccentric exercises.
I'll keep ankles warm as possible.
I'll stretch the hell out of my calves.

Hope it will all work.

I had for over a year. It was bad and would click when walking up or down stairs. Finally stopped running in the morning and iced instead. Sat on recliner with ice pack on Achilles. Ran at lunch or after work when everything was loose and kept it easy and flat routes. I iced again after run and again at night. Took NSAIDs and after two weeks it felt almost gone. After 3 weeks it was gone and even after speed work on hills it's still gone. Stupid that something so easy helped me. I believe it was also causing my plantar fasciitis because that went away as well. I did laser therapy and stretching techniques that didn't work and my physio wanted me to buy orthotics and tape it which I declined. Good luck.

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This is my post from a similar discussion about a year ago. At the time, I thought my running days were numbered. A few months after this post, I ran a 60K trail race followed three weeks later by a marathon. It's a year later I have still have no achilles issues. My take away- Find a good physical therapist and establish a working relationship with him/her.



Has anyone successfully 'beated' tendonpathy?

I have. I had been dealing with achilles tendonitis for about a year. I finally went to my PT who put me through a series of 5 treatments. Each treatment consisted of 1) tx with a TENS unit followed by 2) Cupping on my calf muscle followed by, 3) Dry needling followed by 4) the Graston technique (scraping of the calf muscle with a dull metal blade. Man, it hurt).
I've been putting in some long runs preparing for an ultra in several months. This past weekend I did a 17 mile (fairly hilly) trail race without any issues. And I won, crushing my nearest competitor by 20 minutes!!! Ok, I'm lying about that last part. But I was pain free for the race and after.

I'm beating it right now. I have a little less common version where my pain is on the sides of my feet, calcaneous insertion. I have been going to a therapist for a week for has done some ART and graston on that area. Besides that I am doing a progression of exercises prescribed by a poster on this very forum.

https://forum.slowtwitch.com/forum/Slowtwitch_Forums_C1/Triathlon_Forum_F1/achilles_tendonosis%3F_P5490176-3/

I've heard the science is still out on the graston technique, but if people are saying it works then perhaps it's something to try.

I've also heard that icing and anti-inflammatories may not be helpful, but obviously this is not necessarily true. i.e. I heard anti-inflammatories may work in small doses but prolonged use may in fact have a negative impact on healing.

Wifey has been battling it for 10 years on and off. Last three months have been the worst for her. She went to two different doctors recently and just got a PRP injection. Time will tell if this works but after talking to the two different doctors, there is definitely a difference in how the PRP is spun, amount, placement, etc. If you are considering PRP, I would suggest you interview a few doctors.

Hopefully this works for her.

Once again, consider how you are loading your tendon. The science supports loading protocols. This is a really good article.

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If you over pronate orthotics are the tx.

I'm a little blown away to come on here today and find this post as I've just been researching my own issues with Achilles tendinitis. Based on what I synthesized from the data on sites like WebMD, Mayo, etc., it's not at all uncommon in older athletes and it's usually worse in colder weather. Nothing much was offered in the way of treatment beyond strengthening the calf muscle. I had to discount that one as I have comically large and powerful calves. My takeaway from the internet research was that this is another "welcome to old age" items. You didn't say how old you are, but ...

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Stay aero my friends.

I'm the original poster, and 44 years old. So yes, classic textbook, in the male, 40 to 50 category most likely to get this sort of tendinitis.

The past few years I've been blaming the injury on the fact that i increased my mileage too suddenly and too quickly in order to train for a longer trail run, but after reading all of this and doing more research, it seems like this is only part of the story. Poor circulation, tight calf muscles, tight hamstrings, potential pronation, gait problems, not engaging my quads when running...all of this probably has some bearing on why i got injured and why it's not that easy to get rid of.