If you have haglunds, just have the surgery.
I’ve had both sides done (no detachment) and returned to running less than 10 weeks after the second procedure. I know surgery is never the first option, but it seems like you’ve been suffering for a long time.
All the tips in this blog post are helpful! Especially try the achilles "flossing" technique :)
Putting heel lifts in my shoes has done wonders for my insertional Achilles tendonitis.
Try doing some seated calf raises, and HEAVY slow resistance calf raises (start without a heel drop/use the floor)
streak wrote:
This video advice helped me a lot
Go light on stretching when it hurts, but try to loosen the calves with massage. Take magnesium, because it will help with muscle knots. Wear shoes with soft heel counters when running and don't have anything touching the back of the heel when going about your day. Try natural anti inflammatories like turmeric and ginger. This is a frustrating injury but it WILL get better!
I agree with most of this. Find shoes with soft heel counters. I use to run in Pegasus and the heel counter was super stiff and irritating. I switched to the Clifton and added a 2/3 insert under the one it comes with.
do your calf raises from the floor for a couples weeks. Regress to progress.
don’t take anti-inflammatory meds. Inflammation is vital for the healing process.
I dealt with insertional for years and tried everything I've seen listed here (iso hold, laser, extracorporal shockwave, yoga, flossing, taping, flat heel drops, therabands, different lifts, months of running off, ect.).
Oddly, the one thing I never did before was deadlifting and after 4-6 weeks of deadlifting it started getting better and eventually went away. If I get away from deadlifting for an extended period it'll come back....but just a couple sessions make it go away again. Nothing crazy heavy either, just 4-5 sets of body weight a 1-2xweek did what nothing else could.
To the original poster:
If you live anywhere near the East coast, consider Dr. Paul Tortland in Glastonbury, CT. He injected my left Achilles twice and my right Achilles once. All 3 times, the Achilles felt better the next day.
He uses concentrated dextrose in water rather than the polidocanol favored by Dr. Alfredson. The diagnosis is aided with ultrasound and the injections are guided with ultrasound.
Dr. Tortland also got me into some off-the-shelf orthotics that were better suited to me vs. the custom ones I had worn for years. Good luck because Achilles pain sucks!
Agamemnon wrote:
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.
Shockwave is pure pseudoscience, and I wish I never did it
I had major haglund's deformity, so not the same issue, but I have been unable to resolve it after years of trying. I eventually got surgery and was never the same running since. Went from 7min miles and 80mpw to 9min miles and 6 mpw. Anytime I bump my mileage my achilles starts to really hurt again again and I don't ever want to go through that surgery again.
Had bad Achilles for years. Would come and go and compromised training for years. ESWT was helpful. PRP was very helpful. Eventually turned in surgery for Haglunds and now no problems.
+1 for doing lots of eccentric heel drops, but absolutely no stretching. It will aggravate the injury. Wear a heel lift or some kind of shoe with 8-12mm heel to toe offset with all activity (including walking to the bathroom at night)
Hey just wanted to share my 2 cents. Same thing happened to me at the end of my college career; pretty much ended it honestly. But there is definitely hope.
Taking some time to rest if you have a current flare is a good idea. Initially I would cut out the heel counter in all my shoes to minimize irritation of the area. Can always do that with your shoes.
One thing I am doing know is I have transitioned to running in Altras. With a careful transition I’ve noticed a zero drop shoe has helped actually lengthen my Achilles and taken away a good amount of pain.
i am also training for a marathon and have noticed doing some heart rate based training for my base has helped me slow down my miles and allow my Achilles to adjust to volume.
Just anecdotal ideas and sharing!
i wonder for those people who have had this issue for a really long time, i.e. decades, and assuming they are eating and sleeping healthily, if it is just genetics, maybe their achilles is too short or too tight, and there is not much that can be done to solve the root cause.
I've dealt with Achillies/plantar F for nearly 20 years. Cycles of getting in shape, then the pain comes back....I am still not cured but I have spent the past 2 years rebuilding my body from years of poor nutrition and over training. Here is what I have done that seems to be working (it's just taking a long time due to trial and error and fixing 20 years of poor biomechanics).
1. Chiropractor regularly saw her every month, and more in the beginning, now I am down to once ever six months if I keep up on massage.
2. personal trainer- to help with learning how to lift heavy (where the Fvk was this knowledge back in early 2000's when I was running in college?!) I used a trainer for about a year. Important lifts to learn or muscle groups to target: Deadlifts, hip thrusts, gluteus medius basically any banded exercise where you're activating and working your hip adductor's and abductors/ glute med, give more attention to working your entire posterior chain from the back of your neck to your soliuses.
2.5 Nutrition- almost forgot... When I started lifting heavy I also started to eat my body weight in protein every day
3. Soft wave therapy- After I started getting stronger I felt I was hitting a plateau and I was lucky that my chiropractor also started offering shockwave therapy a.k.a. soft wave. they did a lot of sessions on my hip more so than my PF or my Achilles which was a surprise. But I found I eventually hit a different Plateau with this as well.
4. Physical therapy- one who looks at your entire body... he made some great adjustments to my metatarsal/tarsel articulations so I could close the angle a bit more between my shin and the top of my foot. After this adjustment I felt a significant more range of motion in my arm swing range of motion- a reminder that everything is connected! he also worked on my SI joint, hamstring insertion, and sternum/rib cage (I had a pretty bad fall off a horse a few years ago)
5. Compression boots. I bought the norma tech compression boots. what might be an important tip for using these is to extend your legs out as far as possible and as straight in alignment as you can as the compression gets tighter and tighter as the boots fill with air.
5.0 massage- semi regular full body massages....
6. total ankle strengthening exercises not just calf raises. I think this is my final key to curing my Achilles/PF. My hip and glutes are way stronger with much improved range of motion with all the deadlifting and hips thrusts I've done.but my lower leg is still on the stiff side. I've never had shin splints but I wonder if my weak shins show up as sore Achilles. I started putting weight on the top of my foot and lifting it. Also started using a balance board...single leg balance exercises rotating the board with CONTROL in a circle. It's difficult and I definitely feel my hip stabilizers starting to fire!
Other important notes: I've barely run for the past 2.5 years while trying to strengthen my weaknesses. I have a really great running community nearby and am dying to get back to groups runs, but also not going to repeat the same injury cycle. I've turned all my passion for running into lifting and riding horses (dressage). It's so important to have another activity while you cure you body! *I lift with a lot of focus and control. It's critical you are engaging the correct muscles while lifting and utilizing the entire range of motion. Mirrors are key when working on balance and straightness. A personal trainer was a game changer for me, but so was YouTube channels discussing proper lifting form. I follow a few body builders social media, they are especially lifting/technique/anatomy savvy!
I'm on IG and twitter if someone might have anymore questions, just google my username.
Dealing with mid portion tendonitis for about two years at this point.
After failing sticking to a rehab regime I structured myself, I got some guidance from treatmyachilles.com this January. They do really care and cater everything to your needs. "Finished" the rehab program in late April. It got significantly better and thought I could start running again but had a big flair up, so my achilles is still not ready for running.
Just got PRP a week ago in both legs. Probably the most uncomfortable/painful treatment I ever went through lol. I know about the research regarding effect on achilles tendons but just had to go with it and try. The pain from the injection is slowly going down but had to walk like 5k yesterday and flared it up a bit again. Probably starting with isometric holds next week and work my way from there. Also been supplementing 15mg of collagen + vitamin C for a year now since studies show it helps the healing process of tendons.
One you'll always have to keep in mind is that tendons need at least 12 weeks to renew their cells. So a lot of advice is not accurate when people say this did not help but that did cause they either did not do it long enough or the benefits where still there but not showing until later when they tried something different.
After dealing with achilles tendonitis (bilateral) for decades, I started doing absurd amounts of eccentric heel drops with a weighted backpack. The pain in the body of the achilles resolved, but I started having severe pain at the insertion (also bilateral). It was as if the pain just descended from the tendon body to the tendon insertion.
X-rays show Haglund's on both heels, but the limiting factor for me now is the pain in the left heel. The right doesn't give me much trouble.
I was prescribed a custom orthotic for the right foot years ago, and I use that on and off. It's certainly no cure.
I've also tried shock-wave therapy, which itself was painful as hell, but it had little or no effect on the Haglund's pain.
Hokas relieved the pain for several weeks, but it returned. I've recently switched to the Nike Air Zoom Pegasus 39, which seem to minimize the pain. I'm beginning to think that the relatively narrow heel and wide forefoot of the Pegs may be helping.
I don't see the point of surgery unless I can determine and correct the biomechanical problem that caused the Haglund's in the first place. So that's the approach I'm taking now.
I recently started doing the exercises described at the link below to increase supination by strengthening the muscles that insert on the inside of the ankle (tibialis posterior, flexor digitorum longus and flexor hallucis longus; see diagram in linked article).
I've already noticed a change in the way my feet meet the ground, both when barefoot and when wearing shoes. And the Haglund's pain is now fairly negligible until I get to about 45 min into a run (I'm running about 35 to 40 mpw).
We'll see. Hope springs eternal, as they say.
Good luck.
https://human-movement.com/why-subtalar-joint-motion-is-critical-to-walking-and-running-and-how-to-improve-it/#:~:text=Subtalar%20joint%20motion%20is%20critical%20to%20both%20walking%20and%20running,joint%20motion%20and%20improve%20it.
This injury really varies in regards to recovery time. I’ve heard months, but I think if you really attack this you can hope for much quicker. It’s super great that you don’t have any calcification or haglunds deformity because that would make surgery pretty much necessary with a much longer recovery time. I cleared mine up in about a month (also had no calcification or bone spur). Here’s some tips and what I did:
Take time off initially. I think I took about a week. Don’t stretch or strengthen. Just ice and gently roll out your calves a couple times a day. Try to stay off your feet. Basically just try to keep inflammation down.
Don’t take ibuprofen. There’s evidence that this negatively impacts tendon healing. It’s tempting, but don’t do it.
Sleep and nutrition are super important always but even more so when dealing with an injury. Aim for 8+ hours if you can. Collagen + vitamin C, magnesium, calcium, protein… all are important.
Sleep with a night splint. Not one that keeps your foot dorsiflexed.
Week 2 I would start strengthening. The isometric holds and eccentric heel raises are ultimately what’s going to fix the problem. Keep up with everything else mentioned above, but add these exercises. Continue to do more and go for longer with weights as you can.
Like others have mentioned, run a little bit. I would take a few days off every week still but a couple miles will help you. I think I averaged about 15 mpw for weeks 2-4. No long runs. I avoided going over 4 miles even if it didn’t hurt too much. Ice immediately after.
I would look at your shoes. Minimal drop is best. Look into a heel lift for running and walking around in general.
I had large nodules on the back of my heels. I cut off the back of my shoes which made it feel a billion times better. If you can have as little as possible touching the back of your heels, then that will be helpful in the healing process.
Patience is key. I know you mentioned a fall marathon. I think you should look into one for next spring or fall. Having a solid year of high mileage behind you is good for a successful first marathon. You’re still so young anyway. So many marathons left to run!
It wouldn’t hurt to go to a sports doc and get more imaging tests done just to see what is happening with the tendons.
I never went to PT. I just didn’t think it was necessary. These things take time, but the strengthening and decreased volume really should help.
It will get better. It’s hard I know. It sucks especially since it’s summer and everyone is out running. Focus on your weaknesses now so this won’t happen again. Every runner goes through an injury here and there - it’s really what makes your successes as a runner that much more rewarding. By strengthening, you’ll be stronger in the long run. Good luck. You have some great advice on here!
BumAchilles wrote:
I just graduated from college where I ran competitively. I ran decent mileage (around 90ish). Anyway, I’ve had achilles pain basically since the end of November and have run about 10-15 mpw since then. It completely took me out of my last few seasons of college running. The trainer at school told me that it just needed to rest, but I’m starting to get frustrated because no improvement has been made and I’ve been resting for 7 months. I finally went to a podiatrist yesterday and got an x-ray which showed no calcification and no heel spur. They told me to keep running 10 mpw but to stretch my calves and wear a splint at night. It was diagnosed as insertional achilles tendonitis. Again, it’s frustrating because that is all stuff I have already been doing. I also have a noticeable nodule on the back of my heel that is red and hurts to be pinched. The podiatrist, my trainer, my PT (haven't gone yet for this injury as it's too expensive for me being a new college graduate), my yoga instructor at school, and a massage therapist have all said I have the tightest calves... could that be the main issue?
So, I’ve been stretching, rolling out, wearing a night splint, icing, cutting out the backs of my shoes, doing the calf raises, and running super low mileage… is there anything else I should be doing? I know there are many threads on this, but if there is no calcification or heel spur, am I doing any damage by running on it (sorry, that’s probably a dumb question)? I was hoping to run a fall marathon, but it’s starting to seem like I wouldn’t have enough time to get in shape even if my achilles miraculously healed itself tomorrow. It doesn’t hurt a ton to run on. I’m just worried about making it worse at this point.
I’m just feeling a little desperate because my podiatrist didn’t really seem to care. And I do know that not doing a fall marathon and resting for a couple more months instead is not a big deal and so insignificant… I know it’s just running and all. I really just miss it a lot, and a group of my coworkers (all training for the NYC Marathon) always meet up to run after work, and I’m so, so jealous. Sorry that this is long and thank you so much (can’t emphasize the thank you enough!) for any advice, tips, thoughts, etc.
I'm a runner of 50 years. I had this from 1977 until 2011 off and on depending on my running.
My solution was intense deep muscle massage to loosen my concrete tight calf followed by active release therapy by hand. It took 1 year. Very painful but have pain free ever since.
Good luck, do not give up.
jefflovestorun wrote:
I'm a runner of 50 years. I had this from 1977 until 2011 off and on depending on my running.
My solution was intense deep muscle massage to loosen my concrete tight calf followed by active release therapy by hand. It took 1 year. Very painful but have pain free ever since.
Good luck, do not give up.
I should add I've kept up the deep muscle massage on my calf. That was the key for me. I noticed you also have very tight calves Tight calves effect how flexible the foot can move during foot strike and push off. I also have high arch which means rigid foot so with tight calves causes most the force going to the back of heel/ insertion point and over time becomes very painful/bumps can occur (as did mine). I could stretch with no pain and am very flexible so stretching and strength did not help. Can't stretch a concrete tight calve.
Sorry you're having issues. I had non-insertional tendonitis and that was bad enough - eccentric drops and rest did wonders. I just came here to say thank you for the excellent thread.
Thank you so much, everyone!!
This might be a silly question, but if it is tight calves, would I just treat it the same way? Honestly, all of my extra money is going towards paying off my student loans right now, so i really shouldn't be spending my money on massages. Would a foam roller and a lacrosse ball work, too?
I feel like there is a good chance that the problem is my really tight calf. This is embarrassing to admit, but I've been running since 8th grade and have never really stretched or rolled out before. I was dumb and thought it was more productive to use that time to run extra miles. Looking back, I wish I could change that thinking now! But as I mentioned in my first post, everyone comments on my tight calves and the PT I saw last year mentioned how horrible my angle flexibility/foot mobility was (because of my calves).
