MRI Results Today

I injured my Achilles Tendon in a 20K Trail Run back in November. I had run a 14.2 mile race about 5 weeks before that. I just was not able to get over the AT injury, despite rolling back my mileage and finally got a MRI.

The results are listed below. I wanted to see if someone here could explain how this happened. I didn't get great answers at the doctor. I go see the ankle specialist on Monday.

Could this all be from the injury in November?

Could this be from a severe ankle sprain I suffered while playing racquetball 15 years ago that I never had extensively treated? (no MRI back then)

I lost over 100 lbs in 2022-23 with running being a part of that. Could it be that the obesity played into any of this and I just didn't know it was there? (I didn't have issues until the AT injury though, except for a strained upper hamstring while doing speed work in September.)

Any insight would be appreciated as well as what my ortho specialist is likely to recommend.

MRI Results:

1.Mild to moderate Achilles tendinosis. No tear. Associated peritendinitis.
2.Small focus of moderate to severe chondral thinning along the far medial margin of the talar dome with underlying degenerative subchondral cystic change and reactive edema. No osteochondral fragment.
3.Chronic low-grade sprain of the deep fibers of the deltoid ligament.

This post was edited 58 seconds after it was posted. Reason provided: grammar mistake

Have you done any targeted exercises for it? Rolling back mileage isn't going to heal achilles tendonitis. If you haven't, do single-leg eccentric calf raises nearly every day and slowly build up added weight to them.

I injured my achilles in February, and I initially just rested the entire week. At first it seemed fine and I did a test run and didn't have any issues afterwords, but then I ran again the next day and it immediately came back with full force. After that I stopped running and focused on doing eccentric calf raises (look up Alfredson's protocol) where I'd stand on the edge of a step on my toes on one leg and then slowly lower myself down. My achilles would hurt more immediately after the exercises but it didn't matter, it would settle down again pretty quick. I built up to doing 3x30s then started adding weight. After about 4/5 weeks I had gotten up to 30 pounds extra weight and my achilles pain was pretty much gone and I was able to start easing back into running. I'm getting back to my previous mileage now with no issues.

The science behind this is that, like muscles, running can cause microtears in your tendon, which ideally should heal the same way as a muscle. However, tendons are not vascular and heal very slow, so if you're constantly causing more microtears than it can heal you end up with tendinosis where your tendon is inflamed from your body desperately trying to heal the tendon. However, another issue is when your body does heal it, it throws collagen fibers down that are all randomly oriented, when they need to be oriented parallel to each other to actually be strong and function properly, otherwise the second you do anything strenuous you introduce a whole ton of microtears again. Eccentric calf raises resolve this by constantly reinforcing the parallel orientation of collagen fibers, as well as constantly letting your body know it needs to focus an effort on repairing the tendon. Eventually, once you're adding weight, you're progressively rebuilding the tendon's strength. After a while you also want to start doing things like jumping jacks and one-legged hops to rebuild the tendon's springiness and stiffness.

Good luck on your recovery and stay optimistic.

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