I’ve been struggling with achilles tendonitis for 5 months now; I went to a sports medicine orthopedist and he had an x-ray done and there is a calcium deposit on the heel. The doc feels that the spur doesn’t help but sent me to PT and I went through 10 sessions with some improvement but when I run it’s almost back to square one. I decided after my last run on November 23 to just completely rest it, but even now, three weeks later I still have pain. The doctor says that if I have the spur removed it would help but also says that it would cause them to come back sooner. I can swim and bike with no problem, but as soon as I even start to run it go backwards. So, with all of that said, what to do? The spur does exacerbate the tendonitis, but if I could even get a year or two without pain it would be awesome. Anyone with this problem before and what did you do? What would you do…surgery?live with it? Thanks
Most insertional posterior heel spurs don’t need to be removed, but some do. Would need to see an X-ray and correlate clinically. If you have failed PT (I’ll simply assume what was done), rest, etc. then surgery is always there, but should be your last resort. Is your pain at the posterior heel only and not up along the achilles tendon?
Most insertional posterior heel spurs don’t need to be removed, but some do. Would need to see an X-ray and correlate clinically. If you have failed PT (I’ll simply assume what was done), rest, etc. then surgery is always there, but should be your last resort. Is your pain at the posterior heel only and not up along the achilles tendon?
The PT helped somewhat but the pain is always with me. Right now I’d say a 2 out of 10 most of the time. It’s on my left and I do have a bump at the heel and the pain is usually focused at that point. When I run it swells and the pain is usually up to an 8 or 9. I also have pain on each side just above the heel. It isn’t or doesn’t radiate up the tendon. Thanks for your input!
Then you have posterior heel pain, not really “achilles tendonitis”
This is important because the traditional conservative achilles therapies (ie posterior calf stretching, eccentric heel drops, etc.) are much less effective with insertional tendinopathies unfortunately.
Disclaimer: I am a chiropractic physician (D.C., NOT a M.D.), acupuncturist, ART provider, etc. I do a lot of things to get my patients well.
I’m yet to have a case of achilles tendonitis/ tendonosis I haven’t been able to clear up, typically around 20-25 treatments depending on age/severity. They have all come from failed PT, surgical consults, etc. Not one has had to completely stop their activities of daily living, I often ask them to go for a recovery run/bike post treatment when they’re ready.
Typically the inflammation at the site/bone spurring is due to a chronic tension on the insertion from the gastrosoleus complex, however other muscles such as peronei muscles can contribute. To put it bluntly, what I usually see is excessive tension/tightness. There is such a strong “pull” on the achilles that the insertion can’t heal and starts to become inflamed to limit protect the area.
The spur your discussing is due to a traction effect of the achilles on the periosteal fibers of the calcaneus, it may or may not resolve with treatments. I have not seen one that was so large it caused problems.
A BIG caveat: If there is any type of partial thickness tear whatsoever the above statements do not apply, its too late for a quick and full recovery.
Chiropractic adjustments to the area are typically less helpful in this example, but do contribute to functional biomechanics.
ART to the tissue that is contributing to the chronic tension is VERY helpful, however the achilles tendon is one of the thickest in the body and has a terrible blood supply so it heals very slowly. This is not a comfortable process, although the masochists of slowtwitch probably wouldn’t mind.
I add acupuncture and occasionally Chinese herbs to help expedite healing, although I may start using a normatec sleeve in my standard protocols to see if recover is further accelerated.
Skeptics feel free to flame me, or send me your problem cases so I can fix it and avoid a unnecessary surgery and get this guy back out competing.
byfthalone if you or anyone else in New England has this issue and wants to commute to Cape Elizabeth, ME for the required treatments I’ll gladly fix it.
Dr. Zev
I have the same insertional achilles problems with a large spur. Not sure if it would help to have it removed or not. It is a really frustrating problem and sorry you have to deal with it. I am 12 months out of the initial problem. It took me 6 months until I could run more than 2 miles. I tried PT with graston and all the exercises and quit them after about 8 months. Seems time gradually was healing it. And I mean gradually. But now I am able to do HIM distance. I take 2 days between days of run training. Maybe I could do every other day, but that would be pushing it. Running every day is completely out of the question. The days after the run the achilles is quite stiff. After my run I put on this stuff called Pennsaid, which is basically a topical anti-inflammatory. And the night after I run I wear a nightsplint. Plyometrics and lunges really seem to bother my achilles. I am done with those. Good luck. It sucks
I had the same thing. Then I ended up having Haglunds Deformity. I had an operation and after 6 months I am 100%. No pain, and my run times are faster than before. You just have to be willing to not run for 4 to 6 month. You can still swim and ride. Good luck!
I’ve been struggling with achilles tendonitis for 5 months now; I went to a sports medicine orthopedist and he had an x-ray done and there is a calcium deposit on the heel. The doc feels that the spur doesn’t help but sent me to PT and I went through 10 sessions with some improvement but when I run it’s almost back to square one. I decided after my last run on November 23 to just completely rest it, but even now, three weeks later I still have pain. The doctor says that if I have the spur removed it would help but also says that it would cause them to come back sooner. I can swim and bike with no problem, but as soon as I even start to run it go backwards. So, with all of that said, what to do? The spur does exacerbate the tendonitis, but if I could even get a year or two without pain it would be awesome. Anyone with this problem before and what did you do? What would you do…surgery?live with it? Thanks
When I was diagnosed with the same issue, tendonitis, I was issued no running for 8 weeks, none, zero, nada. Bike all I want, swim all I want. That I did. I had other components of therapy also that I followed. Return after 8 weeks was gradual. Year later, now, I am running 60mi/week with no issues. I stretch and calf roll regularly. 5 months of dragging and achilles issues is a sure way to a serious chronic condition. I am no expert, but this forum is littered with posts like your on achilles. You will not run yourself through that one without long term damage. Trust me. I am tough too and can suck it up. This one is not about that. What do you do with spur, I have no idea.
Then you have posterior heel pain, not really “achilles tendonitis”
This is important because the traditional conservative achilles therapies (ie posterior calf stretching, eccentric heel drops, etc.) are much less effective with insertional tendinopathies unfortunately.
I’ve had the insertional tendinopathy for coming up on a decade now… haven’t found anything that works. The eccentric heel drops have cured all the simple achilles problems for me, but the heel pain persists. I took six months off running this year, it got better but it never gets well.
The things that help:
- ice it several times a day, use alternating heat/ice treatment at home - two buckets, one with ice water, one with hot water, alternate.
- a night splint like the Strassburg sock or the plantar fasciitis boots
- eccentric heel drops on flat ground - raise up on both feet to a demi-pointe position, lift healthy foot and lower ill heel to the ground, repeat until calf fatigues.
I had the same problem, which kept me out of running for over a year, which I initially thought was achilles tendonitis.
You may have what can be defined as “retro-calcaneal bursitis”, where a spur/bursa forms on the calcaneus. This is probably due to overuse of the soleus muscles, due to excessive hill running and improper bike cleat positioning. Try massage your soleus muscles and you will most probably feel a lot of tenderness.
Your soleus muscles could be treated by a physio/chiropractor by means of dry needling and/or cross friction. Don’t stretch your calves as this will make it worse. Also, walk for 5min before and after all training runs and add hill training gradually.
Check your bike pedals - the smaller the pedal, the greater the chance of a running injury being caused by cycling.
I actually had bilateral Haglund’s deformity and ended up having bilateral surgery in 1987 as I was an alpine ski racer ski boots and the Haglund’s deformity did not mesh well. I had bilateral osteotomies with the removal of the deformity and bilateral achilles tendon transfers. Was given zero PT to do. I ended up just riding/racing bikes as soon as the casts were removed (6 wks of cast). The left achilles is good and asymptomatic. The right was never quite well again. Although now is more unwell than before.
I had the exact same problem and almost stopped running for good. I went to specialists, PT and even took 8 weeks off with no improvement. I finally got a video analysis done at a local running shoe store and found out that the real problem was that I just needed a stability shoe. I changed shoes and got Superfeet inserts and am now running 50 miles per week with no problems. As soon as I feel any heal pain I know my shoes are worn out. I still run short races in minimal shoes but all training and 10k or longer races are in a more substantial shoe. I did a 50k about a month ago and had no pain at all. It can’t hurt to get a video done and see what it looks like. Good luck and don’t give up!
I had the same thing. Then I ended up having Haglunds Deformity. I had an operation and after 6 months I am 100%. No pain, and my run times are faster than before. You just have to be willing to not run for 4 to 6 month. You can still swim and ride. Good luck!
Hey there.
How is this going for you? Looks like I might need a similar procedure.
I had insertional tendonitis at the beginning of 2012 and was also told to do no running for 6-8 weeks. I came back and ran a marathon in August of that year. Leading up to the marathon I was running 90-100km weeks (50-60 miles). I was patient (I’m normally not). It was frustrating as hell, but the results speak for themselves.
Some things that helped me:
- Heel drops on flat ground (built up slowly, from 8x2 using both legs to go down, to 10x2 going down on one leg, to 15x3 on one leg with weight);
- Lots of foam rolling. 20 mins twice a day on both the calves and heels. I used a tennis ball or a golf ball to get the nasty spots;
- Light static stretching 3 times a day. When I say light, I mean feel the stretch, but no straining;
- Ice for 3 weeks followed by heat for the next 10 weeks;
- I bought one of those $5 heel lifts from a pharmacy and put them in my walking around shoes;
- Sleeping in a compression bandage.
I’ve been pain free for a year now. The root cause of my injury was weak, tight calves. For prevention I do heel drops 4 times a week (2 on flat ground, 2 on stairs), foam roll a lot and run more of my milage on trails.
Through the PT, I avoided surgery and injections. Bone spurs complicate the issue, but there are PT techniques available to reduce their size and effect. Surgery is an option, but should always be a last resort.