Please Help!! Insertional Achilles Tendonitis Not Going Away

I have dealt with it for 25 years. Roll but don't stretch or wear night splint. Both make it worse because the achilles can't be stretched. Don't run in the morning. Try to stay off feet and don't do a 2nd activity. Warmup slowly. I go a year or two without a problem but then I run and have something going on later in the day that requires standing or activity and the problem starts. I have had to take 8 months off two different times to get it to simmer down. I got one cortisone shot in the bursa 10 years ago which was great but I don't want to do it again due to the risk.

Have also been dealing with this for a very long time. Doesn’t seem to go away. Qualified for the marathon Olympic trials twice and my achilles has made running nearly impossible. Have basically quit running at this point. Time off doesn’t seem to help. There doesn’t seem to be one right answer for achilles pain. Good luck to you. Hope it works itself out.

I think you should set your focus on a fall 2023 marathon, though. It sucks to be in that space where you think you have a shot but know you should be training but can’t. Good to not be too disappointed.

Have to say, it’s great there’s no calcification or heel spur yet. I’d still be careful and avoid high mileage.

Things that helped me:

0 running for about 12 weeks (sounds like you already did this)

Wearing crocs/clogs as much as possible. Don't let anything rub against the back of your heel when possible.

Methylprednisolone pack helped to reduce the inflammation and pain when the injury was initially unmanageable. Not a permanent solution.

I wear heel lifts in my work shoes and wear SuperFeet Orange insoles in my trainers.

Agree with the poster who said to limit morning running when possible. If you need to run in the morning, try to take a warm footbath and walk away as much stiffness as possible before you run.

When in doubt, stop, walk home. Try again in a day or two. It's frustrating.

I'm surprised no one has jumped in with the usual recommendation of eccentric heel drops. Some people swear by these. Other people, who have true INSERTIONAL pain, say the exercise aggravates the injury even more. I do them on occasion when I have 0 PAIN. If you are experiencing pain, don't try them.

Thank you all for the responses. It's such a frustrating injury, but I appreciate the recommendations more than you know.

I'm in the same boat brother. Graduated two years ago and started getting insertional achilles tendonitis last year. I've essentially done everything possible to resolve the pain but it has not gone away. I can run 3-4 times a week but I think my days of running 80+ mpw are over.

Achilles injuries are the worst, sorry you're dealing with it. If you can find a podiatrist that performs ESWT (shockwave therapy) there are some studies that show that can be helpful, although I think it's usually not covered by insurance so you may have to pay out of pocket. If you google a guy named Keith Baar he's done some research suggesting taking collagen or gelatin with vitamin c before working out can improve tendon strength.

Otherwise I've found when getting back into running after taking time off for achilles injuries I always still feel some pain at first. I've had to build back up slowly (starting off just running a mile every other day) and go from there. As long as the pain isn't getting worse I think sometimes you have to run through some initial pain and see if it gets better over a few weeks. But if the pain gets worse during a run or is much worse the next day that probably means you're doing too much.

I've had some similar issues but I had some calcification in my achilles. My orthopedic doctor gave me PRP injection and it has been beneficial as PT was not helping at all

Read the linked article, and start trying the heel drops again. Eccentric heel drops should work for both kinds of achilles tendonitis, but for the insertional type, you likely need to stop the drop motion before you go beyond horizontal, to target the right area. The linked article explains it pretty decently.

I've had a whole string of stupid tendon-related injuries the last three years (getting older sucks). I had midpoint achilles tendonitis for the longest time, and the heel drops and other PT helped. Then, while dealing with an ITB issue, my achilles problem moved down to the insertion point. My physical therapist altered the heel drop protocol to target the insertion area (in line with what the article describes), and that therapy has worked very well. In addition to stopping before going below horizontal, she has me drop down fast, and "catch" myself at the horizontal level, which amplifies the targeted stress.

If you have decent health insurance, or can save up some cash, find a good PT for a consult and see if that will help (ask your local runners, if you can, or fly to Portland and see Matt Walsh). I've had good luck with my current PT solving lots of problems that I'm constantly causing, and she's been much more helpful than my doctor, podiatrist, and whoever else. (My current injury, which has severely limited my running for about four months, is a result of some very ill advised suggestions from a podiatrist.)

Good luck with the therapy, because this injury sucks eggs, for sure.

i run barefoot a lot so i got an achilles overuse injury in both legs, it took nearly a year to go completely, and when i was searching google a lot of people were reporting a very lengthy healing process. you have to find a balance between training and resting. complete rest won't be getting any blood to the area. too much running will setback the healing process with too many micro tears to the muscle.

if you are using a low heel, use a shoe with a higher heel and more cushioning so your achilles is working less. and try and run with a midfoot strike not forefoot so much.

once the injury is close to healed, start strengthening exercises so the same thing doesn't happen again in the future. calf raises and heel drops.

Have you tried doing isometric holds? I was having significant Achilles pain to the point where I could barely walk getting out bed in the morning. Did what you said you did -ice, stretch, calf raises, reduce running volume- didn’t really work.

Spoke to my buddy who is a physio and she said do a set of 6x10sec isometric hold with 5sec rest with a straight leg (go to 1:10 in this vid for an example https://youtu.be/arLsa_isSOw) and 6x10sec isometric hold with a bent leg (https://youtu.be/aX8HjVWY23c)

Within 2 weeks I was almost pain free, within 6 weeks I’m running completely pain free and back up to 50 miles the last week with a tempo workout

The physio also said do calf raises every second day as long as the Achilles allows

I should clarify that by calf raises I meant eccentric heel drops. 3x8-10 straight leg and bent leg. Also the iso holds can be done as frequently as you’d like - from how it was described to me by the physio it’s very therapeutic for the tendon

Make sure it is actually tendonitis, and not the early stages of a haglunds deformity. Look into Tenex treatment, in any case. Drop a nuke on the problem before it progresses. I struggled with it very seriously for seven years, got Tenex, am now doing 70% better, able to do 100 miles per week, win races, etc.

Heavy weights are your friend. I completely overcame this kind of issue through weights, and I mean standing double-leg calf raises with 100kg+ barbell on my shoulders, and 120kg+ seated. It hurts, but that is part of the journey to recovery. Maybe start with with isometrics, and of course, build up to this load. I was taking NSAIDS for 2-3 yrs of chronic issue, but after a while of weights it was zero. Good luck.

Try using mole skin to make a donut. also find that the theragun can help. Definitely consider a full leg workout routine. the Recover app (expensive) can guide you through some leg exercise rehab that addresses Achilles

I battled with 5 years of insertional achilles tendonitis here which (cause/effect, I don't know) resulted in me having a large Haglund's deformity.

I had an osteomtomy on that 18 months ago, and - although it still requires careful management (icing, night splint), am able to train fairly normally.

the problem with a lot of this advice is people are trying the thing that they say healed them a long time after the initial injury, so you can't be sure it is that new thing you did that actually helped. it could just have been healing on its own or healing from an earlier thing you tried.

and I'm not sure about the lifting heavy thing, at least not until the injury is healed or almost healed. definitely agree that lifting heavy to prevent future injuries works, but to recover from a current injury... hmm.

You guys are amazing (huge understatement!) and have no idea how much I appreciate your responses. Seriously, I’m so appreciative and thankful you took the time to post. I'm listening to all of it and will give everything a shot. Thank you all!!

The Achilles can take a long time to heal. I'd give it full rest -- walking only -- until you have a full week without any pain or niggles. (That might take months.)

Also, I can tell you what worked for me after years of Achilles problems: a vegan diet. Not trying to proselytize here, but I went vegan and the problem disappeared. The change in diet cut down on Inflammation in my whole body. Give it a try for a little while (or at least cut down on meat and dairy). No promises, but maybe it'll work for you, too.

plant based diet has been proven to speed up muscle recovery. but inflammation is part of the healing process, this is why ibuprofen use is now discouraged as it stops the inflammation. inflammation subsides after a few days or at most weeks anyway, but these achilles injuries drag on for months and years, long after the inflammation has disappeared. in the mid and long-term, diet generally is important - iron, zinc, calcium, especially protein.

If you literally wait until there is no pain before you run again you won't be running at all for a long time. I think it is okay to run after a few weeks but you have to sacrifice some of your mileage depending on how it feels. Pushing through pain is only going to make it worse. I like to work the area so blood flows through it and brings the red blood cells or whatever it is that do the healing. Whether that be exercise or massage or water jets or whatever.