Incurable Achilles pain - time to hang up the shoes forever?

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  • aKILLeeze
    2 years ago 06/04/2018 1:37am CDT
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    I'm a 26-year-old runner (well, WAS a runner) and I've suffered from Achilles pain since 2015. I'm out of ideas on what to do. Back in 2015 when this started, it would just bother me enough after a few months that I had to take a month off and start up again once the pain was gone. I did this over and over until early 2017 when I basically gave up on running because the training stints were getting shorter and shorter. But I really want to reach my goal of breaking 30 in the 10k.

    The pain is low on the inside of my heel near where the Achilles joins the heel bone. It is not agonizing, but hurts every step in certain motions enough to make me slightly limp, especially when walking uphill or if I do any running at all, even if I just jog across the street. Or if I'm wearing tight shoes like rock climbing shoes I really feel it.

    I have been to two podiatrists:
    -Doctor 1: the podiatrist that treats the Brooks-Hansons Elite team
    -Doctor 2: a podiatrist who has treated Flanagan, Rupp, Ritzenheim, Rowbury, Radcliffe, etc.

    Doctor 1 (2016): X-rayed, initially said it was minor Haglund's deformity and later tendinitis. Tried:
    -eccentric heel raises (flat-ground, unweighted, weighted), doing them religiously at very high reps
    -using a walking boot for up to a month, done twice
    -cortisone shot
    -electrostim treatments

    I also tried on my own:
    -icing, heating, alternating between icing and heating with a special heat/ice pad sock
    -sleeping with a Strassburg sock
    -wearing an ankle compression sock
    -a ton of supplements touted as helping with tendon health

    None of these things helped at all besides maybe the cortisone shot. The pain has always felt like it's at 90% at best and no better. I gave up until I was living near another reputable running doctor. So I haven't trained since April 2017 (about 14 months off of running now).

    Doctor 2 (2018): X-rayed, said it was tendinosis. Tried:
    -3 EPAT + electrostim treatments (he said it's successful in 85% of patients and that only 30 machines exist in the world, so I was banking on this helping...)

    After waiting three months, I didn't feel any improvement, but I still tried a 30-minute run. I felt pain after a few steps but was so frustrated I finished the run. I was limping really bad for the next week and thought it was going to explode. Never doing that again.

    So after EPAT treatment failed with no improvement, he had it MRIed and said there is nothing obvious in the MRI besides bursitis and the heelbone is slightly long (so I guess Haglund's?) and recommended surgery, shaving down the bone and removing the bursa.

    Should I go ahead and do this, or hang up the running shoes forever? I can't even play any rec sports that involve any amount of running. I'm just afraid surgery will fix nothing. But I've sunk a couple thousand dollars into doctor visits so I might as well follow through with SOMETHING.

    I can post the X-rays if requested.

    TL;DR: I have tried most Achilles treatments with no improvement in 3 years, even with the last 14 months off of running. Will surgery help? Any experiences with this surgery?
  • aKILLeeze
    2 years ago 06/04/2018 1:43am CDT
    re: aKILLeeze
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    I forgot to mention that I wear Superfeet inserts in all my shoes with a small foam cutout under the heel portion. I made sure none of my everyday shoes are too tight and pressing on the Achilles. I plan on cutting out the heel counter of my running shoes if I ever run again in my lifetime. I would always run in the Pegasus that I now discovered were a half-size too small, so maybe that exacerbated the issue.
  • zzzz
    registered
    2 years ago 06/04/2018 2:45am CDT
    re: aKILLeeze
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    I had pain in the same place. I'm not a medical expert, so keep that in mind. Some thoughts:

    - Try to identify the root cause, because you'll be right back to injured if you don't figure it out. If you have Haglund's, it might have been caused by always wearing shoes that are too tight. Abnormal bone growth is stimulated by pressure. It's probably similar to my feet likely having bunions because I wore shoes not wide enough for my feet when I was growing up. You seem to already realized this, but rethink your shoe sizes for all shoes, and go a larger than you think (full size, rather than half size). I don't think it was the cause in my case because, other than a pair or two of shoes over a lifetime of running, I haven't had heel counter-against-heel pressure.

    - Unless the pain is really bad, don't take breaks from running. Tendons degenerate if they aren't used/loaded. They get worse if you rest, as you found out. Very slowly build back up to running without overdoing it.

    - Forget the Strassburg sock. Insertional Achilles problems are caused by compressive pressure of the Achilles pressing against the tissue between the Achilles and the heel. You don't want your foot dorsiflexed all the time putting pressure against that tissue. This link was shared in another thread recently that helped me visualize the issue, and then I tried to avoid doing things that do that. Look at the picture where the retrocalcaneal bursa is highlighted in red: http://www.runningwritings.com/2011/09/injury-series-flat-eccentric-heel-drops.html

    - This was the thread that I just mentioned: http://www.letsrun.com/forum/flat_read.php?board=1&id=8791075&thread=8781812#8791075

    - Watch the Jill Cook (2) and Ebonie Rio (2) presentations in this playlist (got it from that thread) for ideas on how to approach rehabilitation. That way, you won't do things like take time off thinking that will help with recovery: https://www.youtube.com/playlist?list=PLEyFKL_-aBmynP-B-EreIO_gD1dh19Fxc

    - You have to be consistent with rehab exercises and be systematic about adding weight/stress (including from running). If it were me, I'd try more rehab before doing surgery, because I think you did some things, like time off running, that made things worse, not better.
  • Subway Surfers Addiction
    2 years ago 06/04/2018 5:05am CDT
    re: aKILLeeze
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    Is electrostim the same as electroshock? I found it helpful, but you've got to get out of shoes with (normal) hard backs that flex. Go get some Adidas Ultra boost STs, you will notice less pressure. But also surgery might actually help you.
  • Been there-
    2 years ago 06/04/2018 5:20am CDT
    re: zzzz
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    zzzz wrote:

    - Unless the pain is really bad, don't take breaks from running. Tendons degenerate if they aren't used/loaded. They get worse if you rest, as you found out. Very slowly build back up to running without overdoing it.


    +1
    keep jogging on soft terrain
  • Brian359
    registered
    2 years ago 06/04/2018 6:04am CDT
    re: aKILLeeze
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    Everything you described I went through. They also put me in a cast for 6 weeks just so I could stay off it completely and heal, no luck. Eventually I did the surgery for Haglunds, have not had significant issues with my Achilles since. I was 24 at the time and kept training seriously for 5 years. Recovery from surgery was not fun though.
  • ex-runner
    registered
    2 years ago 06/04/2018 6:36am CDT
    re: Been there-
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    Been there- wrote:

    zzzz wrote:

    - Unless the pain is really bad, don't take breaks from running. Tendons degenerate if they aren't used/loaded. They get worse if you rest, as you found out. Very slowly build back up to running without overdoing it.


    +1
    keep jogging on soft terrain

    I'm not sure, I had incredible Achilles pain that would not go away for many years, despite the rehab I tried, but after a significant period of rest (in excess of one year) they felt much better.
  • TPT
    2 years ago 06/04/2018 6:49am CDT
    re: aKILLeeze
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    Get the trigger point therapy workbook by clair davies - amazing guide for self-treatment of myofascial pain
  • GlobalView1
    2 years ago 06/04/2018 6:51am CDT
    re: aKILLeeze
    Forum Index
    I didn't see it mentioned in your list of therapies, but self-administered cross frictions are worth a try at this point.

    I've been doing it for a chronically bad achilles and it's reacted very well. Sure, I still get mild swelling after a rigorous week, but just sitting down and getting your thumbs into the sore spot(s) and moving across the tendon with high pressure seems to get me back on track. I do three or four massages x 1 minute each time and that seems sufficient.
  • Trying to help
    2 years ago 06/04/2018 6:57am CDT
    re: Brian359
    Forum Index
    What everyone is saying is pretty accurate. The surgery is almost always successful. You will be able play any sport again without any discomfort or limping. However, you probably won't get 100% of your stength back in the tendon. In other words, your push-off from your foot won't be as strong. This will make running sub-30 tougher, if not impossible. If you want full-strength back, you're better off rehabbing without surgery.

    Here's your big question: When have you exhausted all rehab methods, and are ready for surgery?

    If it were me, I'd try some of the more conservative methods mentioned on this board. However, if it came to the point of either quitting running competitively vs. surgery, I'd get the surgery.
  • Jackass
    registered
    2 years ago 06/04/2018 6:59am CDT
    re: aKILLeeze
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    Have you tried an epidural? I had two and they really helped- no joke I literally gave birth to a new achilles!
  • Not dean
    2 years ago 06/04/2018 7:01am CDT
    re: aKILLeeze
    Forum Index
    aKILLeeze wrote:

    I'm a 26-year-old runner (well, WAS a runner) and I've suffered from Achilles pain since 2015. I'm out of ideas on what to do. Back in 2015 when this started, it would just bother me enough after a few months that I had to take a month off and start up again once the pain was gone. I did this over and over until early 2017 when I basically gave up on running because the training stints were getting shorter and shorter. But I really want to reach my goal of breaking 30 in the 10k.

    The pain is low on the inside of my heel near where the Achilles joins the heel bone. It is not agonizing, but hurts every step in certain motions enough to make me slightly limp, especially when walking uphill or if I do any running at all, even if I just jog across the street. Or if I'm wearing tight shoes like rock climbing shoes I really feel it.

    I have been to two podiatrists:
    -Doctor 1: the podiatrist that treats the Brooks-Hansons Elite team
    -Doctor 2: a podiatrist who has treated Flanagan, Rupp, Ritzenheim, Rowbury, Radcliffe, etc.

    Doctor 1 (2016): X-rayed, initially said it was minor Haglund's deformity and later tendinitis. Tried:
    -eccentric heel raises (flat-ground, unweighted, weighted), doing them religiously at very high reps
    -using a walking boot for up to a month, done twice
    -cortisone shot
    -electrostim treatments

    I also tried on my own:
    -icing, heating, alternating between icing and heating with a special heat/ice pad sock
    -sleeping with a Strassburg sock
    -wearing an ankle compression sock
    -a ton of supplements touted as helping with tendon health

    None of these things helped at all besides maybe the cortisone shot. The pain has always felt like it's at 90% at best and no better. I gave up until I was living near another reputable running doctor. So I haven't trained since April 2017 (about 14 months off of running now).

    Doctor 2 (2018): X-rayed, said it was tendinosis. Tried:
    -3 EPAT + electrostim treatments (he said it's successful in 85% of patients and that only 30 machines exist in the world, so I was banking on this helping...)

    After waiting three months, I didn't feel any improvement, but I still tried a 30-minute run. I felt pain after a few steps but was so frustrated I finished the run. I was limping really bad for the next week and thought it was going to explode. Never doing that again.

    So after EPAT treatment failed with no improvement, he had it MRIed and said there is nothing obvious in the MRI besides bursitis and the heelbone is slightly long (so I guess Haglund's?) and recommended surgery, shaving down the bone and removing the bursa.

    Should I go ahead and do this, or hang up the running shoes forever? I can't even play any rec sports that involve any amount of running. I'm just afraid surgery will fix nothing. But I've sunk a couple thousand dollars into doctor visits so I might as well follow through with SOMETHING.

    I can post the X-rays if requested.

    TL;DR: I have tried most Achilles treatments with no improvement in 3 years, even with the last 14 months off of running. Will surgery help? Any experiences with this surgery?


    Run on trails. Running on hard pavement is a joke.
  • Treating Symptoms
    2 years ago 06/04/2018 7:21am CDT
    re: zzzz
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    zzzz wrote:

    - Try to identify the root cause, because you'll be right back to injured if you don't figure it out. .


    +1

    All this work and you haven't had your gait checked out?
  • RuppBuster
    registered
    2 years ago 06/04/2018 7:22am CDT
    re: Not dean
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    Not dean wrote:

    Run on trails. Running on hard pavement is a joke.


    yeah he could give up entirely and become an ultra runner
  • fisky
    registered
    2 years ago 06/04/2018 7:29am CDT
    re: aKILLeeze
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    aKILLeeze wrote:

    I forgot to mention that I wear Superfeet inserts in all my shoes with a small foam cutout under the heel portion. I made sure none of my everyday shoes are too tight and pressing on the Achilles. I plan on cutting out the heel counter of my running shoes if I ever run again in my lifetime. I would always run in the Pegasus that I now discovered were a half-size too small, so maybe that exacerbated the issue.

    It sounds like this could be a shoe-related injury and you've even identified why it might be the shoes, but you haven't mentioned if you've actually tried changing to a bigger shoe AND to a different model. Why would you stick with a shoe model that has caused a potentially career-ending injury?

    You should find a shoe that fits differently in the heel than the Pegasus and try it. I suggest you read the online reviews and try one of the Hoka models... not the Bondi 5, but the Cavu or Mach or Bondi 4.

    The dilemma you now have is that even if you find a better shoe, it might only help prevent a reoccurrence in the future. It might not actually cure the injury now, especially considering that you are wearing other shoes when not running.

    When I had an injury in a similar location (PF of the heel), I realized that shoes might be a contributing factor. I switched to a radically different shoe with a rocker sole (Hokas) to shift the landing point of the foot.

    Dry needling cured the injury. The Hokas kept it from returning. I'm positive the Hokas helped because I would occasionally try another shoe and the problem would start to resurface.
  • Not dean
    2 years ago 06/04/2018 7:41am CDT
    re: RuppBuster
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    RuppBuster wrote:

    Not dean wrote:

    Run on trails. Running on hard pavement is a joke.


    yeah he could give up entirely and become an ultra runner


    You mean an actual real runner, not a hamster
  • No just no
    2 years ago 06/04/2018 7:57am CDT
    re: Not dean
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    Not dean wrote:

    Run on trails. Running on hard pavement is a joke.


    Don't listen to this idiot. Studies show that hard surfaces are better for achilles injuries than soft ones.
  • musclessfitness
    registered
    2 years ago 06/04/2018 8:01am CDT
    re: aKILLeeze
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    All the conventional remedies won't work. They never helped me and I don't think it helped the majority.
    You can easily get through pain once you realize that your body is a whole chain and that what you do with your upper body and your hips is more important than the small Achille muscles or ligaments.

    Check my youtube channel. I'll be producing some easy ways to get through any injury.
  • Youre the idiot
    2 years ago 06/04/2018 8:11am CDT
    re: No just no
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    No just no wrote:

    Not dean wrote:

    Run on trails. Running on hard pavement is a joke.


    Don't listen to this idiot. Studies show that hard surfaces are better for achilles injuries than soft ones.


    Right, because in general its better to run on unatrual hard pavement than natural soil and trail. Shut up loser
  • Shoebacca
    registered
    2 years ago 06/04/2018 8:49am CDT
    re: aKILLeeze
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    When I had a similar problem I needed to switch to 12mm heel drop in all my shoes and I needed to basically wear shoes while in my house all day, too. You need to really ensure you are not tugging at your tendon hardly at all for probably 3 months if you want to heal it some. The Pegasus is more like a 10mm drop, so it's too low. You need to use something like a Brooks Ghost or Mizuno Wave Rider for your casual wear. Don't use anything lower than 12mm no matter what you think. Going around barefoot at all is basically idiotic at this point. Some people erroneously think the Achilles is going to heal and strengthen over time so you may as well ensure it is stretched out while it heals. FALSE. If it is stretched you are basically going to experience micro tears and tearing at the already injured spot whenever you try to use it. You need to take all the pull out of the tendon if you want it to heal without exacerbating the tearing. And this takes a super long time like 3 months because the Achilles does not get a lot of blood flow. Observe that the tendon is white and not red, precisely because hardly any blood goes into it. Healing it takes a while. This is also why Achilles injuries are common repetitive stress injuries, because everything around it heals first and we think it's okay to go running when the Achilles is still lagging behind.

    The Strassburg sock give a static stretch to the Achilles while you are lying around, so the good news is you aren't doing activity that would stress or tear at the Achilles. That kind of stretch isn't the end of the world, but it won't really accelerate the long time needed for an Achilles to heal. And if you get out of bed in the morning after that static stretch and think you can walk around barefoot, then you're risking undoing the entire night's worth of recovery.

    You're much better off going around in 12mm+ shoes for the next several months and then when you start back to running you should use 12mm+ drops and eventually when you race again you should probably not go lower than 10mm+ drops.

    To be clear I am telling you the problem is you need your heel higher up, both during healing period and for all your running forever afterward. Guys with super elastic Achilles tendons are going to come on here and say this is wrong advice, but you aren't those guys. You have tendons tearing when wearing 10mm drop Pegasus shoes. You need to go higher.