Achilles Tendonitis

[JaredJohnson]

Can anyone share experiences and wisdom regarding severe achilles tendonitis?

My achilles tendon was bugging me a fair bit for a year or two but then blew up -- no rupture, but lots more pain, MRI shows arthritis and bone spurs or similar in the heel / insertion point, and I received stern warnings from the doc about the possibility of rupture if I don't work to rehabilitate it. I have to rest it aggressively for at least 4-6 weeks, seems like maybe more, will need PT, will probably need a couple more PRP injections after getting one last week, and might wind up needing or wanting surgery. I'm 42.

Wondering what has worked or not worked for others in terms of treatment and (eventual) exercise, how long you've had to stay out of climbing to deal with it, what it was like getting back in, and whatever else I don't know I ought to know about it, from a mountaineering-centric perspective.

I'm hoping to find that there's a certain level of work and treatment that one can do, to actually resolve the issue and get back to going hard -- or at least reach a point where some sustainable PT regimen keeps it from being an obstacle to mountaineering objectives. But I suspect that's all overly optimistic :/

[Hungry Jack]

Mrs. Jack has had chronic Achilles issues for a few years new since she started playing tennis/pickle/paddle regularly. Turned out she had a bone spur right around the attachment on the heel. She had a procedure to shave it down, but it required 2 weeks of booting and 2 months of reduced activity. She is slowly getting better. Just takes time.

I learned more about patience from injuries than anything else. As a 20 year old I wrecked my shoulder (torn external rotator) playing rugby in college, and didn't touch a weight for almost a year. Cleanup surgery on same shoulder 20 years later (after a ski fall and another tear) was about a 2-year process.

Do your rehab work, and be patient.

[andrewhamilton]

Hi! Well I am sorry for you as Achilles Tendonitis is a really terrible injury to get through. Back in my 20s I was plagued by Achilles Tendonitis. I would say you have two challenges ahead of you. First, healing up from your current injury. Then, once healed up make sure you take actions so that it doesn't flare up again.

It may seem terrible right now, but I do agree with Hungry Jack, I advise you to take the full recommended time off if not more. I know that seems terrible right now as it is prime climbing season. But if you let it heal up, then when you look back a couple of years from now I am sure you will be happy to have put the injury behind you.

If you have to push it right now, then its basically a battle with inflammation. Make sure you take an effective anti inflammatory, then are are also taping techniques you can look up to tape it to help you get through. All of the standard RICE methods apply. But I really think the best thing to do is let it heal. Maybe hit the weight room for a while? No need to stop activity altogether, just stop doing whatever flares it up.

Once you get past this (it took me 6 months to get it under control when it was an issue for me), then you need to identify what is causing the problem and fix it. It could be as simple as focusing on stretching your calf muscles (and i would hit the shin muscles too to get the opposing muscles). I've had several leg injuries over the years where the root cause was basically tight calves. Climbing is always going to put a lot of pressure on that part of your body so you might just need to ease back into it slowly, and then if you feel it flaring up then stop and reevaluate.

I struggled with the issue for several years, but for the last 15 years I haven't really thought much about it. So you can and will get through it. But if you take anything away from this I would say be patient and let it heal.

EDIT: Now that I am thinking about it. For rehabbing I remember using a boot, and I also tried some special socks that helped keep my lower leg and foot in a 90 degree position while sleeping. I forget why but maintaining that angle was important for getting healed up.

[vertical_volume]

Sounds like you have something similar to what I deal with. Haglunds deformity and bursitis. My insertional point was always in a ridiculous amount of pain, even if I did nothing for 2 weeks, and no amount of PT or dry needling would help me. It developed over the course of 8 months and then I was dealing with it non stop for another 6 months. Eventually I was presented with the option to get both of my bursa decompressed with lidocaine (I think it was lidocaine) a couple months ago now and that has made an incredible difference for me. My insertional bursa still present pain from time to time, but the pain doesn't linger anymore, it recovers quickly and a lot of the time I don't even get pain from the things that used to cause it. The stipulation is the decompression is very uncomfortable, you have to take it easy for 48 hours and my doc said that it kicks in for some people right away and for others it can take weeks to start working. I was on the weeks spectrum, for a bit I didn't think it was gonna work. I can send you the name of the doctor who did it if you're in the front range, he does it for a handful of professional athletes every 6 months to 1 year, he's one of the best doctors I have found down in the Denver area when it comes to athletes. If your achilles is being shredded by your spurs, then you might have no other option but surgery. Which again, I could point you in the direction of a doctor that has some of the best surgical results in the country for the exact surgery you'd need (works right down the hall from the doctor that did my decompression).

The other option I was presented with was a cortisone shot in each bursa, but that required me to do no activity for 2 weeks so I didn't rupture the tendons. That might help more, but the risk is tendon rupture.

[sftonyc]

I had a very persistent case of insertional achilles tendonitis (though sounds probably less severe than what you were describing). After a lot of different advice, the thing that ended up working for me long-term was eccentric strengthening (I think it was based on something called the Alfredson Protocol, but has been updated over time since then). Just note that if it's insertional-type you do the heel lifts on a flat surface, rather than a raised surface for regular Achilles Tendinitis.

Looking at medical research, eccentric exercise seemed to have more evidence of efficacy than some of the other treatments (caveating I'm reading these as an amateur and not an expert).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216975/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7739229/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9878810/

[mtree]

I have a friend who has/is going through this and its not an easy fix. First, need to bring down the inflammation. This could take a few days to weeks. the usual regimen. The worst is going right back to activities that irritated it in the first place. Just flares up again and sometimes worse and longer recovery.

Stretching and exercise can help, but it has not solved the issue. She has inserts in shoes to assist ESPECIALLY with driving. Yes, driving! She has also been told to only wear certain shoes which do not press on heal or ligament. Fluffy slippers with solid soles for driving. Doc has found bone spurs which may be the root cause of the flare ups. The current options are, A) Ease off activities that irritate it. That includes skiing and certain Pilates moves. B) Remove the bone spurs to see if that's the culprit.

No easy fix at the moment. Sucko options. Hope you find relief soon.

[Doing14ers]

I have had a pretty severe case for going on 7 years now. It got so bad in the beginning that I could barely touch my achilles and there was a visible bump/swelling. At one point, there was small hard bumps that I could feel but they went away. I have been to several doctors and I have heard about various treatments. I was afraid of the bone-spur surgery or dry needling. But I have found various techniques to keep it bay, which I list below. It is always there, but I can still run and hike. Not as fast as I used to, but enough to keep me happy. It takes constant attention. Here is what I do:

- never walk barefoot or just in socks, even for a few minutes, even at home (see below about Oofos)
- massage the tendon by pinching it pretty hard and rubbing. I use a circular motion. This really helps. Do this for about a minute (fingers tire after a minute) many times a day
- I wear Oofos recovery sandals whenever possible. They make a huge difference. I have an inside pair and an outside pair.
- foot roller massager (has some soft spiky things..stand on it and roll with your feet)
- muscle roller for calves (not sure what called, like a rolling pin)
- you want drop in your shoes - zero drop shoes are not good
- put heel-lifting orthotics in any shoe without good heel drop and good cushioning
- gentle stretches of calves daily (standing on a step and doing an extreme stretch is too much for me, I just keep foot on ground and lean forward)
- trying to strengthen calf muscles with calf raises (with or without weights) was too much for me...I just hike and run to strengthen

I'm going to re-read the other posts and maybe consider some treatments, but the above is working for me as long as I stay consistent.

Good luck!

[two lunches]

i can't decide which is worse, Achilles Tendonitis or Plantar Fasciitis. having dealt with both (simultaneously, to make matters worse) you have my deepest sympathies cause it SUCKS.

i have a few suggestions- 1, DOWN DOG ALL DAM DAY. EVERY DAY. yoga is fantastic for stretching, yes of course. but if you're able to focus your practice on some balancing poses, it is (IMHO) unmatched for strengthening your stability muscles. so in addition to most of the *excellent* suggestions in this thread for rehabbing, i would very much encourage integrating more yoga into your fitness regimen.
2, i know no one wants to hear this but i'll scream about it until i'm mute: ice baths. i personally try to avoid submerging my toes when i'm just working on feet/ankles, but if you can tolerate it- go for it. ideally you want to do rotations of cold to heat, so find your favorite heating pad, a tupperware container filled with ice water, and have at it.
3, accept the shots while you work through your PT. they have been tremendously helpful for my arthritis and bursitis issues and i've heard rave reviews about their helpfulness for PF- can't imagine it's much different for AT.

REST UP! (yeah, it's hard. hopefully you can find low-impact activities to enjoy that won't irritate your injury)
be diligent with your PT and make sure you do both legs to avoid any muscle imbalances. happy trails

[Jorts]

I had a very persistent case of insertional achilles tendonitis (though sounds probably less severe than what you were describing). After a lot of different advice, the thing that ended up working for me long-term was eccentric strengthening (I think it was based on something called the Alfredson Protocol, but has been updated over time since then). Just note that if it's insertional-type you do the heel lifts on a flat surface, rather than a raised surface for regular Achilles Tendinitis.

Looking at medical research, eccentric exercise seemed to have more evidence of efficacy than some of the other treatments (caveating I'm reading these as an amateur and not an expert).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216975/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7739229/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9878810/

Yes. Heel lifts at the gym with a weighted bar helped me kick a mild case of achilles tendonitis.

Alternatively or concurrently, consider a powerful anti-inflammatory like dexamethasone. I'd avoid surgery unless nothing else works. Don't do too much too fast. Strength then stamina.

[justiner]

If you want to do an eccentric exercise you wouldn't do heel lifts (concentric), but heel drops. I do explosive heel drops to clear out all the crap in that area around the Achilles after an ankle sprain.

[Jorts]

If you want to do an eccentric exercise you wouldn't do heel lifts (concentric), but heel drops. I do explosive heel drops to clear out all the crap in that area around the Achilles after an ankle sprain.

You're right! I conflated raises and drops. Apologies. Heel DROPS work wonders for achilles tendonitis.

[Wildernessjane]

Sorry you are going through that. I can definitely relate. I’ve had several bouts of Achilles tendinitis/bursitis over the years. The second case sidelined me for about ten months because I kept pushing too hard after it seemed to be getting better. I’m particularly vulnerable to this injury because of a severe ankle break/dislocation 180 degrees backwards so keep that in mind. The last time I went through this, I did a gait analyses and started working closely with a PT on using my forefoot when I walk. In addition to keeping the calves loose with regular foam rolling and dry needling, I feel like this has been a game changer for me. Contrary to what one poster was saying about not walking barefoot, I feel like it’s been beneficial for me to walk barefoot as much as I can so I’m not getting lazy and walking on the outside of the foot. I have to be really careful when walking extensively in mountaineering boots or ski boots because there is a tendency to heel strike or walk on the outside of the foot. Oftentimes if it’s a little bit flared up from this I’ll just walk around barefoot focusing on using the ball of my foot and this seems to help. In the acute phase, I also found it beneficial to use a brace when I slept that kept my foot at 90 degrees. Fortunately, I was able to cycle even when I was at my worst as long as I did not hammer uphill. Swimming would also be a great outlet. Again, my situation may be a bit extreme but I think it can show you it’s possibly to manage this in the long term. At this point in time, I’m not limited at all by this with the exception of not running anymore but that was my choice as I didn’t think it was worth the risk. Good luck with the recovery.