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

Sorry to hear about your Achilles troubles. I've been there. I suffered with Haglund's on my right heel for about five years until I met an orthopedic surgeon who knew what was going on and said he would get me back on my feet. This was after I exhausted most of the options that you have probably already tried, heard and/or read about. The recovery takes some dedication but it was worth it in my case. I am completely pain free in that heel. The surgeon who handled my case said he went around the Achilles, so there was no debridement of the tendon itself. I was also very reluctant to go under the knife as I was about your age at the time. Since then, I've run 2:20 for the marathon. My only regret was that I waited that long and tried all those other therapies that made no difference whatsoever, until I had surgery.

aKILLeeze wrote:

For the other treatments mentioned (trigger point therapy/dry needling/cross frictions), Doctor 1 thought this may help, Doctor 2 said there’s no way it would help.

Try the easy/cheep stuff first, specifically trigger point therapy, cross frictional rub. My 2 cents would be to find someone who does myofascial disruption technique. It is done with needling or pressure and I have had it resolve some old issues like plantar fasciaitis and new issues like an ankle strain after a fall. It is also easier than starting extensive stretching and strengthening routines. If it works, it is fixed and you are back to running. If not, you are no worse off and can still do the new routines.

Would that be true even for the OP who was doing them on the floor, not a step? Why would that be true? Just curious.

Similar story to many here, haven't been able to train consistently since 2012. Tried ART, Graston, eccentrics, cross-friction, show changes, myofascial, rest, ice, dry needling, and PRP injections.

The only thing that got me close to a full return was/is dry needling; if I could get that 2-3 times per week (I can't), I'd probably make a near-complete recovery.

One question for those who've mentioned it: what do you do for glute strenghthening/activation?

It's the only thing I've never tried, largely because I don't know what you have to do to activate your glutes or find any stride imbalances. Everything in the lower legs is ridiculously tight/taut at all times, including the gluteus/piriformis area.

It does make intuitive sense that a problem with the lower leg/ankle would be caused by something higher up the chain.

* shoe changes (used to do barefoot/minimalist, and that worked for a long time, but since the injury it hasn't, so I use more substantial heel now)

Here is the podcast:

https://soundcloud.com/bmjpodcasts/treating-tendinopathy-with

He talks about exercises with bent knee starting at around 3:12, and later talks about other therapies including ultrasound-guided polidocanol injections to kill the extra nerves and blood vessels that can be the body's attempt at repair but end up only causing pain.

A great resource would be Perry Julien’s book Sure Footing. He’s an excellent podiatrist, well known in the running community.

One thing to note is he is extremely wary of using cortisone shots in the Achilles. Can’t remember exactly what the issue was, just that it could cause long term problems in the tendon.

What supplements have you tried?

I’m going to have to agree with the stop taking breaks. Atleast in my own experience with tendinitis and or soft tissue injuries is that don’t respond well to rest. I’ve actually noticed flare ups of old injuries after taking days off from illness/etc. now it doesn’t mean when I had a flare up to go crazy, I’d back off because it still meant something was bothered but I didn’t just rest completely. I maybe didn’t run a hard session that day but that’s about it. If u can try running consistently. Keep the timed runs minimal but consistent is key. Also stop babying the injuries, walk and MOVE. Runners seem to avoid everything they can when injured and laying around and icing 24/7 never seemed to do much in my opinion. Plus if its going to hurt whether you run or not then wth just live!

Hey all,

Just from this thread, I've seen a lot of people who have suffered from Haglund's. I've got a rough case of it right now, but I can't do surgery at this point in time - it wouldn't allow me to perform necessary work functions, for some time and I don't have enough leave to take the whole time out. I can't work in a walking boot/on crutches.

Are there any suggested drills I can do to help? My times have suffered as, for now, I have gone from running 140km a week all the way down to 40-50. My times have slowed from low 16's to high 18's, and it sucks anytime I try something hard.

I have a deteriorated achilles, as can be seen in the X-ray below. It's frustrating, but not really sure where to go from here.

https://imgur.com/a/UcTX4WF

Check out Jae Gruenke at thebalancedrunner.com - worked for me when I was ready to give up due to pain in Achilles’ tendons from running

Sucks to hear so many Achilles issues. My experiences and those I know seem to echo the above, except I do not agree with those that say eccentric heel drops below level are bad for insertional tendonitis/tendinosis in the right case. For my case, it took a short break and anti-inflammatories to bring down most of the swelling in the bursa and insertional area. Then, I built up running slowly and began doing eccentric heel drops as far down as comfortable. This, combined with hip and general strengthening solved my issue. A break from running will cure any tendinitis issues, but if it is coming back right away, that is a sign that the Achilles isn't strong enough for the load. Even if the root cause is bad form, doing additional Achilles strengthening exercises will help with any minor in-balances that can't be corrected or at least allow you to start running again sooner.

Originally I had tried flat ground (~6months) and eccentric heel drops(~1year) with no weight and super high reps (3x150/day). Ultimately, I switched to very high weight and low rep eccentric heel drops and the result was almost immediate. I would use 4x6 every two days at the highest comfortable weight. This ended up being 70lbs or about 0.5xbody weight at the end. The key is to make sure not to overdo the Achilles, and if it becomes painful/inflamed again, rest it until better. Not sure if it is good in all cases, but it is worth keeping in mind if the standard regime isn't working.

For strengthening I did all of the classic exercises like clamshells, hip abduction, etc. and I did a lot of the Postural Restoration Institute (PRI) work. These gave me fairly strong hips, but it didn't click as my hips were still hopelessly interiorally rotated. The exercise that really helped was a standing hip raise. For a left leg example, you stand parallel to a wall and support an exercise ball between the wall and your right hip. Then, standing on your left leg, you raise your right hip while keeping light pressure on the ball by squeezing your left hip/glute medius. This seemed to be the only exercise that isolated the glute medius well enough for me to focus on activating it alone and not cheat with nearby muscles. I did 2x12 twice a day for this.

Also, I used an ice cup on the Achilles twice daily and really massaged it well and I started getting regular sports massages to help improve overall mobility. Hopefully this helps someone.

Same here,

Tried everything.

Finally decided to have surgery. Painful and long recovery but have been pain free ever since.

Wish I would have had that surgery sooner after trying everything for a few years.

How long was the recovery?

Similar to my experience.

In my case the cause was a combination of high mileage plus wrong biomechanics (varus forefoot). I suffered for years training on-and-off and tried everything apart from surgery. Nothing worked. Then I had surgery, it took 2w to walk again, and 6m to start jogging again, 1yr later I ran sub-3 again, and the problem was solved for good.

In my case, since the cause was a badly shaped foot, I know now that if I ever become ambitious again the problem will reoccur. I came to accept my limits are not where I wish they were. I had plenty of warning signs before the op, I ignored them all, now as soon as the pain appear I back off, I care more about my long term healthy running later in life than my performance next season.

I ran 15, 32, 1:14, and 2:37 before the op, I am an hobby jogger now, it sucks but it's the way it is.

I replaced much of my running with swimming and cycling. Not a free choice but better than any alternative.

Once a bone spur is there, there is no rest ice massage strentghening stretching orthotics physiotherapy etc etc that can possibly remove it. It's a sharp protrusion in your heel that as soon as you move starts rubbing on the tendon. With rest the pain goes away, but the spur is still there!

Anyone notice any nutritional patterns with theirs? For instance I noticed if I tried to go pretty low carb, I'd feel tighter in my calves and legs and my heel would be at me. Also including beets regularly in my diet seemed to help but again could be completely unrelated

What supplements did you take for your tendinopathy?

After a year of conservative treatment, an MRI revealed ruptured bursa sac.

Had surgery (bursectomy) and fully recovered in six-plus months.

I was then about 46 years of age and had been running 10 years.

Running well now at a very old age of 72. I am now slow, but run road races and run and walk distance daily.

You must determine what is the cause of your Achilles problems.

A problem with my other Achilles tendon lead to primarily long-term rest--one, two, or three years of road cycling, but I always returned to running. I now suspect my Achilles problems may have been due to shoes that were two small and/or tight calf muscles. With this injury, you have to try all the conservative treatment measures and rest.

Tons of good info in this thread - a keeper for the archives for sure. Like many posters, I had this ongoing for 3 yrs. - came from decades of wearing too-tight trainers. Still can flare occasionally. May seem silly, but what really helped me was wearing at least a 10+ mm drop shoe, loosely tied. You don’t want the heel slipping, but you don’t want it snug. I love my elite 9s, but I gotta hardly tie them. If the heel flares, it’s back to the old peg 33 or Boston 6. By the way, I cut out plenty of heel counters, it didn’t help me at all. Do the ice, do the Advil. (You’re too young to quit.)