I did a new workout routine that included some plyometric work. That night a got a pain in my heel area that has gotten worse over the last few days. I’ve been reading the Noakes book *Lore or Running *and skipped to the section on Achilles tendinosis which seems like it might be the culprit. He said that diagnosing this is simple and that the discomfort will be localized to the tendon and detectable by pinching the tendon between two fingers. He also says that the pain will be felt first in the morning but should go away with walking. He says that if it is a rupture rather than tendinosis that diagnosing should be the same but that the pain won’t go away. He says that a full rupture will be obvious because there will be a gap in the tendon (I don’t have that) but a partial rupture will manifest itself the same as tendonisis. A rupture will prevent normal walking on the affected side and push off will not be possible because the calf muscles are no longer attached to the ankle.
So… I’m exhibiting some symptoms of tendinosis AND a rupture while not able to detect any pain in my achilles when I take two fingers and run it down the length of the tendon. My pain seems right beind the heel where the top of a dress shoe would be but no noticebale discomfort when I squeeze the tendon between two fingers. I definitely have discomfort walking and my calf has tightened up. Since the pain happened after an event with “sudden violent eccentric stretching” (the plyometrics) I’m inclined to think that a partial rupture might be the cause but not being able to pich the tendon and feel pain makes me wonder. Noakes says that a rupture must be surgically repaired immediately while tendinosis will get better with time and some easy exercices. He seems to suggest that cycling is an activity that can continue to be performed.
So I guess I’m wondering if I’m barking up the wrong tree with the tendinosis/rupture given that I can’t feel the pain when I squeeze the tendon and instead feel it more on the heel. Is my pain something else potentially? How would I best treat this on my own? Since we just had the ING Marathon it is going to be difficult to see a specialist anytime soon so I’m also wondering if I should continue swimming and cycling. Any thoughts?
I can tell you from experience, go to the doctor and seek a medical opinion. I didn’t until it was too late and it became chronic, it then took 3-5 months for a complete recovery.
About two weeks ago during a long run I started to feel some discomfort in roughly the same area as you described. I self diagnosed (with the help of WebMd) myself with achilies tendonitis. I finally got in to see a good podiatrist and he determined that I have a stress fracture in my heel. My pain is as you described yours; on the part of the foot where dress shoes rest, and not on the tendon.
Not to say that you have a stress fracture, but the moral of the story is to get it checked immediately. I walked around on mine for almost 10 days before I got it looked it. Now I am in a walking boot for 8 to 10 weeks, and on a crutch for three weeks. It could be worse - can still bike and swim.
Nice to “read up” but your symptoms fit between TWO possible diagnoses that you have given yourself. The problem is, there are others that cause these symptoms (calcaneal stress fracture, Haglungs deformity, retrocalcaneal bursitis, and so on). We professionals are so constrained. Good luck!
So your suggestion is medical school? Figures. Higher Ed is the biggest racket going.
Yeah, the fact that I’m between diagnosis is what has me wondering. Since I did it doing plyometrics it makes me think some sort of rupture/tear. I was actually able to get an appointment with a specialist who caters to runners for Thursday. Unfortunately, my luck with docs has not been great and I often leave with no better understanding and a Physical Therapy prescription that I often will not be able to make due to limited availability of PT’s who know what they are doing and my own busy schedule. I find that I have had pretty good luck self diagnosing and then coming up with my own PT.
Is the doc Thursday going to be able to tell me anything without an MRI? If it is indeed a rupture, what is the window for surgery (Noakes suggests it needs to be done “immediately” but doesn’t quantify a timeframe).
Wait until a diagnosis is established before thinking about surgery. What Noakes is referring to is an acute, large rupture (which it sounds like you do NOT have) in an athlete. Even a full rupture in an 80 year old will eventually heal (slow mind you, and then weak after - but they don’t all need immediate surgery).
As for the MRI - sure, might be needed. Some with have an ultrasound in the office (I do) that can give immediate feedback as well. X-rays will also be taken. Good luck.
Other potential conditions it could be are insertional tendinopathy (possible), bursitis (possible), tenosynovitis (possible), Haglund’s deformity (unlikely), etc.
Therefore, it is difficult to tell you what to do in the meantime. I.e. if there’s inflammation (need anti-inflammatory medication/modalities) but if not (they’re not needed). If tendinosis, need eccentric strengthening. You get my point…
That being said, I’m not going to say do nothing. Essentially, do what you think may work that put you at the LEAST amount of risk of injuring it further. Perhaps swim with a pull buoy.
Fat-if you summarize the previous postings, I think a coherent plan comes through. It sounds like you don’t have a great deal of confidence in your medical team if you feel, “I often leave with no better understanding…”
You are the one paying for the treatment and if you need to be shown your problem in an anatomy text, have it written down, xeroxed, whatever, make sure you do understand the probable diagnosis and treatment plan so that you can follow the directions appropriately.
Most achilles ruptures are further up the tendon, about 4-6cm above it’s insertion into the heel (the older patient can see a tear at the junction of the muscle and tendon still further up.) The ends of the tendon are torn into irregular longitudinal strips. One aid in securing a clinical diagnosis is the Thompson test. Lay on your stomach with both feet sticking off the end of your bed. Have someone squeeze the non-injured calf muscle and you’ll see the foot assume a toe down position. Does the injured side do the same?
Although I agree with rroof that this doesn’t sound like a rupture, I’m glad you have the appointment Thursday. Most ruptures, if present, can be diagnosed without an MRI. Whether or not a surgical procedure is indicated will be between you and your surgeon. Sounds like you are armed with a sufficient knowledge base to ask the correct questions and participate in your care. Good luck.
Thanks. The docs office just called and moved my appointment to tomorrow so I will just take today off to be safe. This is a new doc that I met at the ING Marathon expo this weekend (Dr. Julien). Hopefully I will have a good experience.
I had an achillies issue after some polymetrics with a PT/ running coach in an effort to impove my mechanics. I am in my mid 40s, and the only time I get injured is when I do something other than swim, bike or run. I’ve tried yoga, stretching, weights etc and almost always end up tweaking something. I guess everyone needs to know their body, but I am competely sold on the specificity in training concept. I now run to run faster, swim to swim faster, and bike to bike faster. I will never know if I would be faster with the supplemental stuff but at least I am not dealing with injury or trying to get another session into my work week. I am curious if others have had similar experiences
Just got back from the doctor and actually had a good experience despite not hearing the news I most wanted to hear. I don’t have a rupture. The x-ray did show a spur on my heel so the doc said this was an accident just waiting to happen. He said that the spur was likely caused by excessively tight calf muscles. He told me to take the next 7 days off. I can swim with a buoy and do core work and upper body strength but no running or cycling. He gave me a night splint to help stretch the calf and recommended icing for 10-15 min at least 2 times per day. This along with lightly stretching the calf muscle at least 8 times per day. He also said optional massage therapy or ART on the calf should do the trick. He said if I don’t see improvement in 2 weeks we’ll look at a walking boot. I actually own a walking boot (air cast). Would there be any reason not to wear that now for a few days?
By the way, thanks for all of the info from you guys. The doctor asked me if I worked in the medical profession since I was tossing around the big words correctly. That was pretty funny.
ok…fatbastardrests…let me give some honest advice regarding this achilles. Do not stretch it, let it heal completely first and start a mild stretching program as tolerated. Stretching won’t do you a shit in the beginning but will aggravate the problem.
the walking boot cast is way better than the night splint he gave to keep your calf stretched. You need support for that achilles not stretch. The night splint which is supposedly for calf/achilles stretch is a better tool for plantar fasciitis (believe it or not). I tell you all from this personal experience and being a therapist myself.
I’m sure you are well meaning and probably very qualified. But I feel like I should defer to the doc who just saw me in person, viewed my x-ray and examined my foot. He is a runner himself and I definitely got the vibe that he knew what he was talking about (I don’t usually get that feeling from docs). He specializes in helping runners recover quickly. I see your thinking but since I’m not qualified to examine my own foot I think I need to go with what he said.
I’ve got a third option which for me certainly had various doctors thinking it was a rupture but turned out to be bursitis. Doesn’t show up in an x-ray, pain when tendon moves but no actual damage to the achilles. For me turned out that best treatment was absolute rest in a cast for a couple of weeks but that was only after 6 months of physio, inserts, ultrasound etc.
