Have any of you had achilles tendonitis that lingered until it needed a cast?
I show no signs of rupture nor partial rupture.
Thoughts?
I’ve been doing PT, etc., but I’m just not healing… 2010 is just around the corner and I’m wondering of more aggressive steps are needed… What’s the downside?
Have you tried a night splint to keep it stretched while you sleep?
Whatever aggrevates it… stop. If a walking boot (cast) helps to immobilize, then okay. I’ve been able to bike and swim when wearing a walking boot during the day. And I too sleep in a night splint when necessary.
Casting is not usually recommended. Although this can certainly calm it down, the posterior gastroc and soleus muscle atrophy that ensues can be an issue later. In severe cases, a walking boot is a better option as it take about the same amount of stress off, but still allows some calf function. Several believe that gentle, eccentric loading can help long term as well (once past the acute stage).
I’ll explore a walking boot.
I’ve already done all the standard stuff including:
I’m reaching wits end on this one.
Thanks,
Puskas
I’m dealing with a partial rupture right now, and have read alot of information about the subject. Keep up the Graston and eccentric loading. Those seem to be the best things to heal it, where cortisone has seemed to backfired. Even with tendonitis, the achilles needs muscle stimulation for blood flow and to heal properly, which make the loading the most important aspect.
If its just tendonitis, I think a boot is going overboard. Really you need to go the full 9 weeks, start light, using the 10% plan, starting at about 1 hour a week total. The frustrating thing is its really 4 months away from running, because the rehab is so damn slow.
Anyone done the eccentric loading exercises and solved AT problems?
It seems to make my tendonitis worse. Hot and more inflamed. Do you need to work through this phase or should I not do it until the I feel no symptoms?
As Doc Roof said, make sure you don’t start the exercises until you are past the acute stage. You are just going to prolong it. I would wait another week or so after that to make sure. Then ease into the exercises.
Years ago I was “casted” for achillies tendonitis. I asked the doctor if that wasn’t a bit extreme.
His answer - “It’s the only way I know you’ll behave yourself for 3-4 weeks.” It worked!!!
It seems like casting it would weaken the other muscles in the lower leg so I’m not sure that would really be a good idea … but I’m not a doctor. I had achilles tendonitis in 1994 that was so bad, and showed no signs of improvement after 3 months, that I had surgery. In my case I was told I had so much scar tissue and adhesions that the tendon wasn’t able to move within the sheath. I don’t know if this is the solution for you, and surgery certainly isn’t something to take lightly, but I was back running in 6 weeks. I don’t think ART, graston or shock wave therapy was around then, if it was I never heard anything about it, so maybe those treatments could’ve fixed the problem without surgery. They had me on a stationary bike days after the surgury and in the pool doing pool running at 2 weeks. I was just a runner then so I don’t know how soon I could’ve started riding or swimming (pushing of the wall). I haven’t had any achilles issues since my surgery.
Anyone done the eccentric loading exercises and solved AT problems?
It seems to make my tendonitis worse. Hot and more inflamed. Do you need to work through this phase or should I not do it until the I feel no symptoms?
Tough dichotomy. Rest is best for “tendonitis” in general, yet here we have people “stress” it. The achilles is somewhat unique in that it is the bodies largest tendon, gets the most stress, has no tendon sheath (paratenon only) and has poor blood supply at a part (called the watershed area).
One thing I find is that people often do the eccentric exercises wrong. Remember, an eccentric exercise is one where the muscle (your calf) is contracting, yet lengthening at the same time. A normal, concentric contracture, the muscle contracts and shortens.
When you have your toes/mets on the stairs, drop them slowly (the muscle contracts allowing you to do this slowly), hold it for some length of time. THEN: do NOT contract the same calf to get back up (this is where most make the mistake). Use the other leg or arms on the railing etc. to bring yourself back up. Then repeat. Avoid the concentric contracture of the calf.
Wait until the acute phase is over - then wait another week.
Do the exercises gently and ease into it. Take off your Type A triathlete overacheiver hat when doing them! You are trying to gently heal and strengthen not max out.
read the list of all the stuff you’ve tried… sending lots of sympathy.
(((hugs)))) life w/o running kind of sucks.
read the list of all the stuff you’ve tried… sending lots of sympathy.
(((hugs)))) life w/o running kind of sucks.
Well, I can handle not running. I can handle not cycling. I can’t do either of them now and I’m getting cabin fever!
Whoa guys. Careful with the cortisone in the achilles. You have a very high tension tendon and cortisone will naturally cause that material to become brittle and possibly lead to something far worse. If you must use cortisone…well, not into the achilles.
I have dealt with this in depth while living in Tucson. I tried everything from a bike refit with Poriac at Bicycle Ranch (nothing changed in fit or injury), talks with Andy Pruitt, resting it, massage it, anti inflames. The best product I found for it was called “Tendon Release” from Peaceful Mountain. Homeopathic and it worked. My coach and I also decided to simply ride through it and see what happens. That is a horrible crapshoot to have to make but in the end it worked. I had these problems for 6 weeks. My achilles swelled to 4-5 times the width of my other achilles. It would creak when I extended or contracted it loud enough that it could be heard in the other room. Gord Fraser’s wife worked on my calf since I was getting build up throughout there as well. Pockets of fluid in the calf muscle. I used tennis balls, sticks, foam rollers, everything. I had to be very aggressive with it.
See a P.T. to relook at the tracking of your leg and range of motion you are capable of achieving. Lower a saddle a bit on a bike to release some of the stress. No impact. Casts or boots are not going to help heal the problem. The only protect it from worsening. You need to find the source of the problem and attack it from there.
You need to find the source of the problem and attack it from there.
x2. It sounds like the OP is just doing whatever he can to treat the AT. You need to find what is causing the AT and get *that *to go away, which will help the symptoms go away.
I had it last year in my right leg pretty bad, and I eventually figured out what it was. Super tight calves, hamstrings, IT bands, hips, and just about everything else in my lower body.
6 months off from running, and a strict stretching, foam rolling regimen has helped immensely. All the tightness had been pulling on me in weird ways, and my achilles was the first thing to flare up.
By keeping the tightness away, I’m able to keep the tendinitis at bay.
Judicious use of casting may allow a decrease in symptoms. Unfortunately, as Dr Roof alluded, casting can lead to tightness and atrophy, making rehabilitation more difficult.
A balance, therefore, between protection and immobilization and stretching and strengthening should be sought.
Generally, a weight bearing removable cast for two to three weeks may calm things down and resolve the acute phase. If casted, remove it frequently for gentle range of motion and strengthening exercises. Isometrics in the cast are also appropriate.
There is a dearth of studies to indicate the appropriate conservative treatment for achilles tendinosis. The only validated active modality is painful eccentric stretching. While effective, this may take time to work.
Application of topical nitroglycerin (Nito-Dur Patch) has also been shown to relieve symptoms although the mechanism is poorly understood. In fact, a pro triathlete recently returned to top form after a prolonged bout of achilles tendinosis. This pro apparently credits topical nitoglycerin for his/her recovery.
Non-validated treatments that some have found useful include passive PT modalities, orthotics, ART, and massage. One should avoid corticosteroid injection as this is associated with an unacceptably high incidence of Achilles rupture.
Does an injured achilles ever return to normal size?
I’m just getting back to running after a 3 month hiatus. I still have stiffness in the morning and the damn thing is still inflamed.
A couple of things that work for me:
I’ve had pretty bad achilles tendonitis twice. Both times, the way to fix it was 6 weeks of rest – no running at all. Swimming was OK but no running. (Not sure about cycling as I did not have a bike at the time). Being someone who likes to run everyday (twice a day if possible!) that really sucked but it worked.
Also both times, after about 3 weeks of the rest, it actually felt worse, not better. Then at 4 weeks it felt healed. But I waited an extra 2 weeks beyond that and it was the right thing to do. It always feels healed before it is.