How long to wait before having surgery on achilles?

You should be better by now. Foot doc in NJ. Like tenjet better. would be glad to offer advice.

I would go forward with the surgery. After a certain point, if you’ve been resting for more than year, it won’t really get better on its own. Achilles injuries have ended careers. Just make sure you have a good support system and know that it make take quite a long while before you’re back running.

Would love any advice. Do you think it's worth it to try tenjet before I try the surgery? I'm from Boston but am willing to travel to fix this. Thank you!

I think you're right. Thank you for the advice!

I was in similar metaphorical shoes at the start of 2020. I dealt with chronic tendinopathy and saw the best running docs for about 18 months before deciding to pull the trigger. The rehab sucks but I'm so glad I did it. I've gone from not being able to run 4mi pain free to 100% marathon training.
My one bit of advice - be selfish with your surgeon. You're not some 55 year old who tore the tendon in a pick up basketball game. Running is important to you so make sure the doc has done the procedure a bunch of times and has a great success rate. Good luck!

No, it is not normal. The pain must wax and wane for an additional 4 weeks as the tendon/fascia remodels. However, your pain lasts 7 months. I think it is not normal.

I had chronically bad achilles tendinitis. I had a planned trip to a few countries. Nepal being one. I was considering doing a basic 5 or 6 day hike. It was up and down rough, uneven stairs with 12 kg on my back for 8 hours each day. I was concerned that I may have trouble walking after it.
Result - cured. No more pain.

Do it. I waisted so much time trying all of those conservative treatments (including PRP, Tenex, ESWT, hours and hours of PT, massage, 2 years of rest, dry needling, etc.)… spent maybe five years trying all of that before I finally gave in. Looking back, I really regret not doing it sooner.

I had the surgery 3 years ago. Just ran my marathon pr last October (2.5 years after surgery). A lot of people are worried about the recovery. It does suck and the time it requires varies greatly from person to person. 3 months to 1.5 years is what my doctor said. I think I was out for 5-6 months. You’re young, though, and don’t have any bone growth so I bet it’ll be on the shorter end.

The surgery doesn’t always work for everyone, but it fixed my pain. My Achilles is now better than it has ever been. If you’re still experiencing pain 1.5 years later AND 7 months after Tenex, it’s likely not going to fix itself on its own. Good luck

I would think long and hard about this. If you don’t have Haglund’s why would you opt for open surgery? They will debride your tendon. Maybe they take part of another tendon from your foot to reinforce the Achilles. You will feel the effects of this for quite a while after. I would say double down on some shockwave sessions for a few months + heavy loading of the tendon and see if that helps. You might also try total rest from running for 3-4 months. Huge amounts of collagen+ vitamin c multiple times a day. Unless you have a tear in the Achilles itself opening that sucker up is akin to breaking open Pandora’s box. You do not know what happens after. - person who has had Achilles surgery

I am not a doctor, but have had my fair share of achilles tendinitis and tendinitis and I feel your pain and frustration. In my worst case, it took about 8-10 months out of running, but at the end, after throwing the kitchen sink at it, it eventually healed. Unfortunately, once you get it, the tendon is always going to be a little weak and even when it has completely healed you will have to be extra cautious not to relapse.

According to clinical data and anecdotal experience, surgery is a bit of a crapshoot: works wonders for some, does not work for others. There is not a lot of clinical evidence that Tenex does anything for achilles tendinosis. Last time I checked, the only think that has been clinically demonstrated to work are rest and eccentric heel drops. That's it. No running through pain, night splints, heating before running (a big no-no!! as it allows to run on an injured tendon and add extra damage). From what you wrote, you only really took only 4 months off from running; this is not a lot for a tendinosis, consider giving it another shot and in the meantime do some other activity like cycling, elliptical, aqua running etc.. basically anything that allows you to move your legs without putting much load on the tendon. Good luck!

I went from being fine, zero pain, to hobbling the next day. Insertional Achilles tendonitis. I managed to get running again and just took it easy. It resolved like 90% but never completely. Some days worse than others. Tried all the things, PT, chiro, needling, massage, etc. No improvement. Took a year off during COVID, not better, slightly worse even. Finally saw a doc. He prescribed Meloxicam. No more pain! However it returned once I stopped taking it. So scheduled debridement surgery. My recovery has been long. Almost at 2 years post and I can run 5 miles easy. Staying away from hills and speed as that just caused pain again until I'd take a short break. Hitting about half of my old 50 mile weeks, but I'll take it. Wish I'd opted for surgery sooner. But of course I tried to avoid it. I warm up with dynamics and walking before I run. Seems to work for me now. I continue my own PT daily, slant board, foam pad balancing, wobble disc, etc. It's a process. Adding in strength work slowly. Hoping it continues to improve.

Thank you all so much for taking the time to respond. I appreciate it a ton.

I think I'll give it one more full year of trying to let it get better on its own (no running, lots of strength, eccentrics, ESWT) and if there is still no improvement, I'll get the surgery. I don't need to run competitively anymore. A year ago, I couldn't imagine myself ever saying something like that... but I've just gotten to the point where going on a 3-4 mile jog everyday with no pain would be amazing. Hopefully a year will get me there! If I can remember, I'll try to update this thread next April with my results from taking a year off from jogging combined with progressive tendon loading/ESWT just in case anyone is going through something similar.

Again, HUGE thank you to all of you.

Have a proximal gastroc recession. You walk out of the surgery center (boot for 2 weeks), and if you don't have a spur (Haglunds) it will solve your problem.

Some things to think about. I'm not a medical professional, just my experience, take it or leave it. Going to 12mm offset shoes might be a good idea when the problem is acute, but many runners feel better beyond that with standard or lower offset. It gives more of a stretch, like when you are doing those eccentric exercises. I'm long over Achilles issues (midpoint, insertional, and Haglund-looking bumps that happened periodically over a dozen plus years once I got to middle age), but if I put on some high heeled running shoes, my Achilles feel cramped and "ask" to be stretched more. Maybe my running form (footstrike portion of form midfoot more or less) affects this experience, and it would be different for runners with different form.

I finally figured out the root cause of my issues by trial and error - my posture. I've had tight backside-chain leg muscles since I was a kid doing stretches at soccer practice. I remember standing in front of a mirror sideways as a kid trying to decide what was good back posture because couldn't really tell by feel. I guess I chose wrong for my body at least (to minimize the curve in the lower back/tilt pelvis back) and kept that up. This also manifest itself in my preferring to slouch/not liking lumbar support in chairs and car seats (to minimize lower back curve). That was kind of reinforced a couple decades later watching the movie Without Limits with the "moment of greatest penetration" quote because that tilts the pelvis back too. Those videos saying anterior pelvic tilt is bad for runners also reinforced me thinking that the pelvis tilted-back posture I had was normal.

Last summer, probably reading something I can't remember now, I decided to try the opposite pelvic posture (with the small of the back tucked in like people say to do when doing squats) while running. With that change in pelvic tilt angle, I couldn't even get my legs up enough on the swing forward enough at first for a good stride because of my shortened backside-chain leg muscles, especially going uphill. I concentrated to keeping my heels as low as possible while walking and running up steep inclines (rather than my usual extreme forefoot steep uphill form), stretching those backside chain muscles. Walking up steep inclines trying to keep the heel down felt surprisingly worthwhile. I could feel those muscles begin to loosen up even on my first runs (and dog walks) with that posture. Within a month, my backside-chain leg muscles were pretty normalized to be no longer chronically tight, and my stride was probably less choppy than my previous lifelong stride. Even not stretching at all, the now default range of movement stays a lot better than before. Months later, the Haglunds-looking bumps on my left heel completely disappeared, and on the right side shrunk though it's still there. I haven't had any signs of Achille problem recurrence since.

I can't say that those anterior pelvic tilt videos are entirely wrong, just wrong for me. It's probably a real problem for other people with a different starting tilt, so it shows how advice need to be individualized.
I probably went from posterior pelvic tilt to normal. In my case, I discovered the root cause by trial and error. Maybe a sports doctor/form expert can help someone figure that out sooner, but I wouldn't count on it. I don't think my previous posture looked odd in pictures. But consider how you are holding your pelvis.

Other benefits: I've been cross country skiing about a quarter century, but the increased flexibility in back-side chain leg muscles have improved my classic and skate skiing form dramatically this winter. I can get my feet back under the body better on steep uphills with much more ankle dorsiflexion angles that before, and now I finally get beyond the looks decent, but can tell you "learned-skiing-as-an-adult" form to feeling like my form is flawless, with that changed pelvis tilt position also massively helping ski form.

I’m actually also going to vote for this surgery. Recovery is typically easier in comparison

This is good advice. Pick your surgeon carefully. See one who treats and understands athletes. My son is a collegiate runner and had Achilles surgery last June. He had a second opinion consult with the a highly regarded orthopedic surgeon in our city. I said to the doc look he’s not a 70-year-old who just wants to walk normally he wants to compete at a high level in the NCAA. We got a blank stare. The guy was clearly uncomfortable with that level of expectation. He had the surgery with his team surgeon and nine months later is training normally. Good luck to you!

Has anyone had this done/was it successful?

I really appreciate you taking the time to post this. Sometimes I get overwhelmed by how many things could be causing the achilles pain. I have also considered my posture. I'm embarrassed to admit that at this point I am losing a lot of patience and know these things take a lot of time to figure out and to see improvement in pain levels. I definitely agree that finding the root cause is important (better option than surgery... but, again, I really just want to run again soon).

Thank you for this! It is hard to find a good surgeon in my area who works with serious runners. But this is a really good point and that is great to hear about your son!