Achilles Tendinitis

[Pickled Piper]

Has anyone suffered from this condition? If so what sort of treatment did you undergo? was it effective etc.

I realise I've had a mild form of it for some time ie sore tendons after running or exercising. However, I damaged my tendons more severely a few months back. I've had massage and ultrasound on the tendon but after a few months they are still stiff and painful. I've read about steroid injections and this may be my next course of treatment.

Thanks in advance.

pp

[Rach*]

I've been seeing a sports massage guy, had ultrasound a while ago which helped for a bit but it does recur, so regular deep tissue manipulation and some very deep/good stretches helps

[dealmaker]

I've got this as well - mainly when I use a "cross trainer" - anyone tried changing their trainers/sneakers - to see if that alleviates it?

[Rach*]

I had my gait checked at a very reputable sports shop, after I broke my toe I was overpronating and making it worse. Definately having the right footwear helps.

[renmure]

To be honest you really don't want NSAID injections around your Achilles tendon, there is a fair bit that can go wrong, and if you do end up moving towards one as part of a treatment plan you really need an expert to be doing the jabbing due to the anatomy of the tendon. By "expert" I don't really mean GPs or general orthopedic bods either, but someone who has had lots of experience in doing injections around the achilles.

There are whole text books on differential diagnosis for heel/foot problems and their treatments so it's probably unwise to go into too much depth about what might be beneficial other than to say that it's predominantly caused by mechanical factors so, perhaps more than most injuries, rest from whatever is aggravating it and modifying your activity is the key to recovery.

[spikeyhead]

dealmaker said:

I've got this as well - mainly when I use a "cross trainer" - anyone tried changing their trainers/sneakers - to see if that alleviates it?

Was the only thing that got mine back to reasonable, still can't cope with trainers that come up the back of the ankle.

[Pickled Piper]

Thanks for the responses.

I'm being referred to an Orthopedic Specialist with many years of experience in foot and ankle treatment. If I end up going the cortisone injection route then I should be in good hands.

From the responses, it sounds like I could benefit from seeing a podiatrist also.

pp

[dreamer75]

I had this as a kid. PHysio didn't really help and in the end they put my lower leg in plaster for 6 weeks to allow it to rest (physio was exercises & ultra sound etc.)

I think I grew out of it in the end, nto sure any of the treatment actually helped!

[SteA]

We run combined clinics where I'm a lecturer, the team includes Podiatrists, Sport Rehabilitators and Biomechanists and the team approach gets good results. As well as identifying all the causative factors you also need to learn a bit about the condition, have a look around for tendonosis vs tendonitis here is an example of something you can access just to give you a background:

http://www.bmj.com/cgi/content/extract/324/7338/62...

[EmmaP]

I'd suggest massage and stretching along with a break from running. Give your body plenty of time to recover. When I first started running I did far too much too soon and had problems with my achilles tendons. I took it easy for a while (I rested before it became a serious issue) and did lots of gentle stretching. It is hard when you are committed to a sport but I think that patience pays off in the long term.

I would advise against steroid injections based on the advice given to me by a friend. She works with the Royal Ballet and another dance school in London and has seen cases where the injections have caused damage and made the condition worse.

A good physiotherapist should be able to treat and advise best as they will be able to carry out a proper examination. I've just read your additional post. Yes seeing a specialist is no doubt a fine course of action as they will have specific knowledge and experience in treating your injury. And equally importantly, diagnose the cause.

Edited by EmmaP on Tuesday 20th January 00:22

[sawman]

You probably need a thorough work up to evaluate the damage and then set a treatment plan.

This may involve physical exam. gait analysis and possibly diagnostic ultrasound.

Physical therapy may be helpful in terms of resolving some current issues and possibly helping to reduce recurrance. You may need to make some changes to warm up routines etc. In some cases the mechanics of your feet and legs may be an issue - in this case orthoses may be helpful.

Steroid injections are not a first line of attack, steroids can weaken tendons. Prolotherapy may be a possibility though - this involves injection an irritant solution (Dextrose)to areas of broken down tendon. Best done with ultrasound guidance!

[mechsympathy]

sawman said:

You probably need a thorough work up to evaluate the damage and then set a treatment plan.

This may involve physical exam. gait analysis and possibly diagnostic ultrasound.

Physical therapy may be helpful in terms of resolving some current issues and possibly helping to reduce recurrance. You may need to make some changes to warm up routines etc. In some cases the mechanics of your feet and legs may be an issue - in this case orthoses may be helpful.

Steroid injections are not a first line of attack, steroids can weaken tendons. Prolotherapy may be a possibility though - this involves injection an irritant solution (Dextrose)to areas of broken down tendon. Best done with ultrasound guidance!

OP, you don't mention whether you've been doing any exercises to load the tendon. IME once the symptoms have settled and the biomechanical issues have been addressed you need to load the tendon to encourage it to heal and strengthen. Eccentric exercises, where the tendon is loaded without an active muscle contraction, is the best way to go about this.

[Blue Cat]

Couple of things you should know about cortisone injections, all they do is stop the pain, they don't actually cure anything and if you have damage in the ankle you could make it worse by working it too hard when you don't have pain as in indicator.

The other thing is (and I have had a few of these injections in my ankle) is that they really really hurt!!! They take a very large needle, stick it in your ankle and move it around until it reaches the most painful point and then very slowly inject the liquid. This hurts a lot.

That said, it does work for a while, about a month when you are painfree. But I wouldn't have it done again, I just take very strong painkillers when the pain gets too bad.

[Pickled Piper]

Thanks everyone. It's been said before, but the breadth and depth of knowledge and experience available on PH is amazing!

I've been doing gentle and regular stretching and have stopped any exercise until some recent swimming. I've been receiving deep muscle massage and US from a chiropractor. I should be seeing the orthopedic specialist in a the next few days.

I've been doing some random reading on the internet (always dangerous) but from the comments here I understand now there are several avenues to go down before resorting to steroid injections. I'm sure my gait or structure is also contributing.

Thanks again.

pp

[EmmaP]

Tight calf muscles may also be a contributing factor. I'd recommend deep tissue massage in both calf and achilles areas. This was of real benefit to me in the past.

[renmure]

Blue Cat said:

Couple of things you should know about cortisone injections, all they do is stop the pain, they don't actually cure anything

To be fair, that's not really accurate and, with respect, is a bit simplistic.
Whilst I have cautioned against NSAID injection in this case due to potential complications, NSAID injections do have a place in the management and treatment of inflammatory soft tissue injuries. Another equally important part of the management is advising the patient what to do/not to do in terms of exercise after the injection.

[mechsympathy]

Pickled Piper said:

have stopped any exercise until some recent swimming. I've been receiving deep muscle massage and US from a chiropractor. I should be seeing the orthopedic specialist in a the next few days.

Find yourself a decent physio. Massage and ultrasound is all well and good, but without some rehab exercises it'll come back as soon as you increase your activity levels.

[sawman]

renmure said:

Blue Cat said:

Couple of things you should know about cortisone injections, all they do is stop the pain, they don't actually cure anything

To be fair, that's not really accurate and, with respect, is a bit simplistic.
Whilst I have cautioned against NSAID injection in this case due to potential complications, NSAID injections do have a place in the management and treatment of inflammatory soft tissue injuries. Another equally important part of the management is advising the patient what to do/not to do in terms of exercise after the injection.

Pedant hat on - NSAID stands for NON steroidal anti-inflammatory drug a steroid injection therefore is not an NSAID injection

as you were!
s