Hi guys I stumbled on this forum while searching my diagnosis since it’s a potential sports injury, I’m hoping someone can help me with this problem. I had started a cashier job 4 months ago(9-10 hours a day standing), after 1 month I started to feel dull discomfort in my right Foot but not sure where it was coming from. Within 1 more month my pain progressed to the point it was painful to work, and even more painful to drive… So I quit my job since two months ago, but my constant dull pain has since remained all the time even at rest but it’s not exactly at the back of achilles insertion but just an inch or so to the sides of my heel, little bit more tenderness on the left side of my heel, which makes me feel I lt might be stress fracture or stress reaction??
I got xray, ultrasound done a month ago My xray revealed nothing, ultrasound sound said I have calcification at insertion of achilles tendonitis( achilles enthesopathy) . But I had mri 2 days ago which said achilles tendon appears normal but I know it’s not true because my achilles does feel tight and it’s more discomfort when I dorsiflex my foot. Also when I massage/ rub my. fingers hard to the sides of my heel close to achilles insertion, it feels painfully good so I know that is my problem.
The only other thing I was hoping mri show was stress fracture but it didn’t mention that also. So I’m really confused at this point, I’m thinking either I should get ct scan/ nuclear bone scan to see if that might pick stress fracture / inflammation of calcaneous or calcification at achilles insertion that might be causing me this pain??
Or should I get a diagnostic local anesthetic under ultrasound to see what’s causing the pain?? Eventually I want to try prp and Shockwave therapy, but if all this fails, I am thinking of requesting a pain specialist to do radiofrequency/ nerve ablation or surgeon to do neurectomy of whatever nerves goes to my heel bone or achilles. Is this even a realistic option?? because this has really halted my life, I have suffered with chronic pain before for years so this has really scared me, plus this is in my foot so I can’t do any job, even slight weight on my heel or neutral/dorsiflex of my foot aggravates it.
I have seen like 12 doctors all specialities and no help so I am think of numbing my nerves if that’s even possible without affecting my motor nerves??
Have you tried any rehab yet? While you don’t know exactly what the issue is, you do know where it is. I’d first start just rolling out your lower leg. A tennis ball for the bottom of your foot and a foam roller on your calf. Do this a few times a day. Stretch your hamstrings and lower back very well also. These are things that you can do without worrying about hurting it more (unlike eccentric heal drops, etc.) Might be worth seeing a podiatrist to see if something is wrong with your foot that is stressing your achilles tendon. If you have a collapsed arch or something it could be adding a lot of stress to your achilles as your ankle would constantly be rolling to the inside. Just some thoughts.
Can’t really help I’m afraid, but I had achilles tendonitis once (ski boot induced). It took probably about 3 months of rest to get better - however it never hurt at rest, only with dorsiflexion (walking down stairs was agony).
You are way overreacting to pain for 4 months. Your achilles may or may not be the problem, but it’s clear that diagnostic testing doesn’t show anything. Asking for special tests won’t get you anywhere. You should also know that it take more than 4 months for real tendon calcification to occur. A lack of activity will not help your condition. Your first stop should be a physical therapist and not more diagnostic testing or doctor shopping. Lastly, you should run far and fast from anyone agreeing to do an ablation on your condition.
I’m an interventional pain specialist and there is really no safe ablation targets for the achilles, also it would be nuts to do so even if there were. We can ablate calcaneal nerves for plantar fasciatis, but that would help you.
I would get a good physio, shockwave might help, if there is truly a calcific buildup then some VERY gentle fenestration might help, but generally thats a pretty high load tendon and i’d be super careful what you do after said procedure because rupture is catastrophic. Lots of eccentric loading.
I would also run away from anyone who suggests steroid injection… I generally avoid steroids for load bearing tendons because of rupture risk.
I’ve been dealing with the same thing since Feb but mine was from a running injury. I’ve been through 12 sessions of Pat and been doing my own exercises at home but it hasn’t fully healed. My PT is awesome and a runner and very knowledgeable about the kinetic chain. He said insertional will take awhile and there is no good timeframe for it. It will heal when it heals. Unfortunately that doesn’t work for me (in my head at least) so I’m going to see another person. He works with more manual therapy versus graston and strength training. I’m anxious to see how it goes. First session is Monday. I’m going to discuss PRP with him as well. Good luck!
Thanks for replying, I saw two orthopedic surgeons who said I do have some issue going on with my achilles after seeing the films CD of mri of my ankle and that radiologist report is wrong who said my achilles is normal. I saw a pain interventional specialist yesterday who wanted me to get lumbarsacrial mri which I had done to see if it might be radicular pain, I am waiting on the report but I know for sure it’s my achilles as pain is sides of my heel and back and gets worse on walking and even more especially driving maybe because my foot is dorsiflexed more. I hear popping sounds from it also from that area when I stretch it which is not the case on my other foot.
You said no safe way to ablate achilles nerves, Is that because of numbness risk or motor loss, at this point I would accept numbness over this pain even in all of my foot if it didn’t affect my ability to move /walk on it, I was honestly hoping if all else failed I could try that as my pain is constant.
One orthopedic surgeon said he can do decompression surgery of my achilles, but I rather try some procedure with pain specialist than surgery on achilles.