Achilles Tendinosis - Am I done as a runner?

It’s not over but it will suck taking the necessary time to heal. Mentally you need to find other ways to get the heart rate up. Bike, swim and PT. I would look into platelet rich plasma injections. It will really speed up recovery. it doesn’t always work but worked wonders for me. need to take the time off after injection. $800 Avoid stem cells.

ncbi.nlm.nih.gov

The use of PRP in treatment of Achilles Tendinopathy: A systematic review of literature. Study design: Systematic review of literature

Chronic Achilles Tendinopathy is a common condition that can be challenging to treat. There are many modalities used as treatment ranging from physiotherapy, injections, shockwave therapy to surgical intervention. Platelet Ri...

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I've never had PRP for achilles tendonitis, but have for hamstring tendonopathy. It worked for hamstrings.

The only thing (and I tried many) that solved my achilles issue was EPAT (link below). It took 3 treatments.

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Services we offer - Mid-South Foot & Ankle

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Mid-South Foot & Ankle Specialists provides high-quality, personalized podiatric care at three convenient locations across the Mid-South.

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EPAT stands for Extracorporeal Pulse Activation Technology. EPAT is a form of ESWT (Extracorporeal Shock Wave Therapy). It’s a new treatment developed and widely used in Europe. It treats severe or chronic bone, muscle, ligament, tendon, and nerve injuries.
EPAT uses sound waves to safely increase the metabolism and blood flow to injuries, which helps heal them. We recommend EPAT for patients with severe injuries as a way of speeding healing. It’s also great for chronic injuries that have failed to respond to other therapies. If you choose to get EPAT treatment, you should discontinue all anti-inflammatory medication at least one week prior to the procedure. This includes ibuprofen, Advil, Aleve, and all prescription anti-inflammatories. Tylenol is allowed since it’s not an anti-inflammatory.

I've had both of those conditions for 25 years. They don't go away. The haglunds will likely need to be shaved down and your achilles may need surgery too. If you've tried all conservative treatments without success, surgery is the last resort but it could be your only option.

You are only 28, with the right rehab you could be running again next summer.

I've struggle with Achilles and PF issues for 30+ years. After trying everything mentioned in this thread (none of these helped me) I concluded my issues were related to crystallization of uric acid in my heel (pump bump) and foot (PF). Changing my diet to reduce purines and both drinking apple cider vinegar daily and using it in a compress on the sore spots (to dissolve crystals), seems to have solved my Achilles and PF issues.

With tight calves lower heel drop shoes can wreck your Achilles. Hokas did it to me. I found electroshock therapy helpful. After four years it is time for something more aggressive but not full on surgery. The shock treatment will stimulate blood flow which is lacking in that area. Weighted calf raises and calf stretches will be necessary once you recover from the shock treatment. Don’t ignore the rest of your muscles as tight hamstrings and even a tight back will impact your Achilles.

Might of been called EPAT but I was put under and it was only one treatment. Walked out of the hospital once I woke up but needed crutches the rest of the week. I swear by this treatment. Looking forward to running healthy at NYC Marathon next weekend after not running a marathon since Fall 2020.

I dealt with the same. Honestly try the CEP Achilles brace. Legit made a huge difference for me

I have had AT for 45 years. I too tried everything (stretching, calf raises, eccentric calf raises, heel lifts, long term rest, direct massage, calf massage, calf stick, calf foam roller, standing on slant boards, minimalist shoes, topical ointments, you name it), but about 25 years ago I found a simple solution. After every run, I ice both of them with ice cubes in a plastic zip lock bag for 10 minutes each. Then 1 hour later I ice both again for 10 minutes. I can now run as much as I want and have no issues. They are still sore to the touch, but running and walking around don't hurt at all. If I stop icing them, after 3-5 days the inflammation/pain starts creeping back in and by a week, it is so severe I can't run at all and walk with a limp. It then takes many days of rest and lots of icing to get back to running again. Therefore, I simply ice after EVERY run and I have no issues at all. Yes it is a hassle, but do you want to run or not?

Hi, I'm also 28, and have dealt with achilles issues that sound similar on and off for about 5 years. Fortunately, I've now gotten to the point where I understand what causes the issue and can manage it, but that took a lot of time, a lot of doc/PT visits (many of which were either useless or misleading), and many setbacks after trying to ramp back up too quickly. More context below, but TL;DR It's turned out not to be strictly an achilles issue, but tightness in my FHL that was causing an irritating pull right around the achilles (see here - the FHL is a muscle whose tendon runs from your big toe all the way up to the back of your knee). But, the first 3 foot and ankle specialists I went to misdiagnosed it as run of the mill achilles tendonosis/bursitis - that led to a lot of time spent doing the wrong stuff for it, as the normal achilles rehab program did nothing. The most effective exercise I do at this point to manage it are towel scrunches.

This isn't to suggest that you have the exact same thing I do, but that there are some less-known issues that can manifest as achilles tendinitis which might be worth looking into.

What started it: For context, I ran in high school and college, but quit after 3 years and ran much less frequently after that. After I graduated, I joined back up with a local track club and started trying to work out and get back in shape. I would do daily runs and workouts, but little to no supplemental work (no core, drills, PT-type exercises) that were a staple in college. I ran a cross country race on loose dirt in very skimpy old flats, after not having worn flats for the better part of 2 years, and after the race started feeling tightness around the mid medial part of my left achilles. Stupidly, I tried to run on it in the following days and ended up making it worse. My theory at this point is that I'd lost a lot of the small muscle strength in my feet and lower legs that I used to have from doing drills and running in flats more frequently. Some combination of that weakness plus running in flats on loose dirt (changes mechanics slightly?) seems to have done it.

Initially, nothing that I did made it better and any type of exercise (running, biking, walking, even pushing off the wall swimming) flared it up. Every PT and doc I went to told me it was achilles tendinitis and that I should do eccentric heel raises. It took about a year and a half to be able to run again. By that point I'd completely given up on it and stopped exercising entirely - time was the main thing that seemed to get it back to normal and I still didn't understand why it had happened.

I started to ramp back up - initially I would feel some pressure around the inside of my achilles, the specific location of which would change day by day, but no pain. Gradually that pressure also went away and things seemed normal. But unfortunately, after about 6 months of running, I ended up tweaking the other side in the same way (doing a run on loose dirt). Round #2 took about 8 months to get back to normal. After more unsuccessful PT visits, I bit the bullet and got an MRI for it. The first person who read the MRI (a Stanford 'expert') gave me the same diagnosis and treatment suggestion as previous docs. I ended up getting a copy of the images and taking them around to other doctors, until finally someone noted the FHL inflammation and suggested treating that.

Where it hurts: One thing that was unusual about my case is that the pain was mostly on the inside of the achilles ('inside' as in the part that faces the other leg). It rarely hurts if you push on it from the back, or from the outside. This makes sense given the FHL diagnosis because the FHL runs right along the inside of your ankle, next to the achilles, before passing along the bottom of your foot and inserting on the inside of your big toe. As I've gone through the process of recovering, I've also had periods of 'turf toe', where the inside of my big toe becomes inflamed and sore to the touch (also hurts when running). That is also related to FHL tightness or strain.

How I'm managing it now: Strengthening and activating the muscles of the calf and of the foot. Like mentioned above, I do a ton of towel scrunches and that seems to be the most effective. Foam rolling the calf with focus on the FHL muscle helps with tightness - I do that pre and post run. I actually don't do a ton of calf stretching because that seems to have irritated it at points, but I do a standing FHL stretch that seems helpful and feels great.

In the past, I've tried dry needling. That seemed to be a miracle cure the first person I worked with, but the second time I went the guy nicked something he shouldn't have and it caused a bunch of painful swelling. I view it as a toss-up at this point, worth trying with low expectations. Whether it's worth it also depends on where you live - in some states it's really cheap and PTs can do it (cost me $25 per session in NC), but in California you have to be a licensed acupuncturist to do it so it was $250.

If it flares up at all, I take a day or two off and am particularly intentional about doing the exercises noted above. Missing a run or workout is totally fine if it means getting back to health quicker. Being well rested also seems to have a big impact - I can knock out a flare up in 2 days at this point if I sleep 9+ hours, but if I have a bunch of stuff going on and can only manage 6-7 hours, the flare ups tend to drag out much longer.

Last, I wear shoes that don't rub against the achilles. Adidas Ultraboost 22 are the current ones.
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Overall, I think you have reason to be optimistic that you'll be able to manage it. One of the key takeaways from this whole experience for me has been that there are a ton of bad PTs and sports med docs out there. Seeking a second (and third, and fourth...) opinion is a good idea. You can tell when they are really committed to helping you achieve your goals versus are just going through the motions.

There were long stretches of time where I came to believe that I wasn't going to be able to run seriously anymore which was very difficult. In high school and college my whole identity was based on running, and it was hard to imagine being valued for anything other than that. In hindsight, the year+ period of being unable to run was a blessing in disguise. It forced me to focus my time on other things, spend it around people who could care less about running, and ultimately to appreciate that I had value as a person beyond running. Now that I am able to run again, I enjoy it much more and have a healthier relationship with it due to that period of loss. Not sure if that resonates but it was an interesting and very welcome side-effect of dealing with the achilles issue.

Hope some part of this is helpful - best of luck!

I will sort of 2nd this. I did find massage, stretching around the muscle, slow heel drops and PF sleeves to help but as someone who has tendinitis flare on multiple parts of my body ice was the quickest solution. If you're more serious, set your ac to house to the point where you're a bit uncomfortable and your bones start to chill. In the winter I pretty much don't turn on the heat. I find this more effective long term for inflammation than an ice bath/direct icing. This is only if this is tendinitis vs tendinosis

Hello, please excuse my poor english.

I have been suffering from Haglund's disease and related pain during about 28 years.

I was a 2:33 marathoner at age 26 after 2 years of training, but I could not improve my PB due to this chronic condition. Later I continued to practice a bit with no objective, and I never tried to run at a competitive level after my 30's. Now I'm 56 and I still run 3 times a week (one hour - 12km flat).

The good news is I have no longer any pain since I have discovered, about 2 years ago, that I just needed zero drop shoes with collapsible heelcup. The adaptation was quite fast, starting with 30mn jogging at 5'30mn/km on grass. Now I can push on my heels as hard as possible for my age, it looks almost miraculous.

Altra shoes can be a good option, I own three pairs (including one for trail) and I think I would never buy any other brand.

NB has also some models that could be ok, but with some drop.

I'm 43 and I've also been dealing with Achilles issues for years. I've somehow managed pretty good mileage anyway (50 a week avg). About a month ago I decided to seriously focus on my cadence and foot plant, hitting close to 180. It seems to have made a difference as every run isn't torturous like they used to be. Might be something to try.

Not the OP, but I've been following this thread religiously since I'm suffering from almost the same issue (add on tendinitis on both sides of my foot, too, and it's been a fun few weeks). Just wanted to say thank you for such a well thought out and detailed response -- it was super helpful!

I had this same exact issue -- took about 3.5 years to finally get a handle of. Lots of stretching and pre-hab seemed to do the trick for me. Best to understand that your Achilles will never feel good (especially those first steps in the am) but it will be manageable. Pretty much every run I will be in a bit of pain for a mile or two which eventually subsides.

Most important aspect of my recovery, run fast year round / in minimalist shoes. I had serious Achilles issues at periods when I was introducing faster paces / wearing spikes -- remedied this by doing strides consistently on hills, spiking up and running strides on the track, and changing out of more cushioned higher drop trainers for these paces. Essentially, just don't let your Achilles be 'surprised' by these speeds.

When I read your post I thought somebody was pranking me by describing exactly what I have been through. I am 3 weeks post-Haglunds deformity surgery. I had the exact same situation, mild Haglunds deformity causing huge inflammation of the bursa (this was most of the pain) and very mild tendonosis.

Here's my story. It started 4+ years ago and managed to string together some great training blocks but the pain was almost always present. On a good day it was mild. On a bad day I would be limping the second I finished my run. Here are the treatments I tried: PT, icing, massage, graston scraping, cupping, all calf raise/lift/strength things recommended, changing shoes, lengthy time off, cross training -- and even much more serious treatments such as a PRP injection and Tenex. None of those did anything to treat it. It would feel okay during the time off but whenever I began easy running the pain came back.

Somebody said it earlier. If there is a Haglund's deformity, no treatment is going to help you run pain-free aside from surgery. I repeat, nothing will help stop the pain aside from surgery. It took me three years to accept this and another year to find a doctor who was supportive of it. Where do you live? I would find runners in your area who had a Haglund's deformity surgery and ask them what doctor they saw.

Last week I looked at an X-ray of my heel now compared to before. The doctor shaved the top edge of the calcaneus down to a 45 degree angle so there is no more chance of the calcaneus irritating the tendon or the bursa. He removed the inflamed portion of the bursa and removed some small "frayed" fibers from my tendon (yikes).

During the surgery, the doctor put me under with general anesthesia and I had no pain after the surgery. He prescribed me Oxycodone and I didn't even open the bottle. I was in a splint and crutches for the first two weeks with no weight bearing. Last week I transitioned to a walking boot with a large heel lift (probably 18mm) with instructions to slowly reduce the heel lift over the next two weeks. I can walk around the house without the boot however my range of motion is weakened, it will take some time to get that back and strengthen the tendon again. I am not doing PT because I am an expert in Achilles tendon PT exercises now and I don't need to pay somebody to tell me what to do, I am motivated myself. My doctor expects I will be easy running in 6-8 weeks (8-10 weeks post-op).

My confidence is high now that this will be the treatment that worked. If you have Instragram you should look up Jake Riley's recent post about his (second) Haglund's deformity surgery. That is one of the things that ultimately convinced me it was time to find a doctor to work with me on this.

Find a cross training exercise that you actually enjoy so you can have fun and stay aerobically fit during the recovery.

Good luck. I totally understand what you're going through and I'm sure it's super frustrating. The surgery will be a temporary set back but it's the only thing that will enable you to run for the rest of your life.

I use heat, not ice. I have Haglund's from playing ice hockey confirmed by an orthopedic surgeon and x-rays, which is aggravated by tight calf muscles. My sports chiropractor has me: doing eccentric heel drops, dynamic calf & Achilles stretching during warm-up, and soaking mid-calf and below in a 5-gallon bucket of the HOTTEST water I can tolerate. He recommends heat over cold because the ankle area suffers from low blood flow, which is especially evident in winter/cold weather when I have most of my problems.

I also use a massage gun to loosen my calves and upper Achilles tendon and run all training miles in Hoka Rincons.

Best of luck. I am sitting in the office right now with no pain for the first time in years. get to run a few miles tonight.

Movement can be medicine. The bike, assuming you have a good seat height, fore/aft position cycling can be very good to work on even distribution of muscle groups. Then graduate to weighted lunges, one leg jump rope.

Shoe choice may be best to have at least 8mm drop to ease load however mixing it up with barefoot and lower drop for a small amount of time could provide a stimulus.

Nutrition: this is a tendon, bone, and muscle issue. The issue with a lot of Americans and older athletes is the disparity with magnesium vs. calcium. Your diet could have you skewed with a high amount of calcium and little magnesium so naturally a high contraction (calcium) being tense and low relax(magnesium) The best formula I have found is mag malate 200mg with mag/glycinate 1-200mg near sleeping hours. And this form has no gastro sides

Another tendon/muscle support would be Omega 3s getting 2g of epa/DHA each. This along with copper and everything above has done wonders for my patella tendonitis.

For copper I have about 4oz of beef liver a week this bioavailable source is going to boost your collagen production which helps in connective tissue. An added plus is the retinol bioavailability which enhances vision and bone support/vision. The beta carotene in carrots only has a 6% absorption of vitamin A. I'm not debating a vegan/carnivore. The universal absolute is we are omnivores and I'll have greens- broccoli, asparagus, etc everyday along with animal protein. For digestion and hormones always include full fat milk, butter, yogurt.

Similar situation. I’m 30 and been managing chronic Achilles pain for the last 10 or so years. The last 2 years have had some particularly rough times with severe pain both while running and in daily life. After having to drop out of Grandmas marathon from the pain, I finally swallowed my pride and went to a PT. She did a few sessions of dry needling and that significantly reduced my pain to where I could start doing all the strength exercises others already posted.

One thing I would add that has helped me is scraping. I bought a scraper from Sidekick Tool (there are cheaper brands too) and use it almost daily on the sides of my achilles and very deep into the calves. Immediately following the scraping, I do the slow drop eccentric calf raises and light calf stretching/mobility. While I am not totally pain free, it’s very manageable and I’ve been able to put together a string of twelve 80+ miles weeks in prep for the Monumental Marathon this weekend.

Also, find training shoes with higher heel-toe drops, decent forefoot flexibility, and a heel cup that doesn’t dig into your heel or achilles. The Saucony Triumph 20 has been great for me. Good luck!