Achilles Tendons Treatments

Unfortunately, treatments for Achilles tendonitis and tears have not changed or improved much over the past 30 years. Depending on the severity of your tendonitis, you will be guided through the following “solutions” or “cures”. I’ll give you the treatment and my opinion and experience with it.

Pain be your guide. This will be the first admonition. If it hurts don’t do it. Stop. If it doesn’t hurt, proceed with caution until there is no pain. Then gradually reintroduce your full training regimen. The “no pain – no gain” philosophy is absolutely out when dealing with this condition. If you tend to push your body to limits and not listen to discomfort, this guidance will be next to useless.

Rest. This is usually the first words out of most health practitioners. Since you caused this by overdoing it in some way, backing off is reasonable. However, I would recommend reviewing your training logs and first eliminating the specific type of workouts that most likely caused it. If removing the suspected workout doesn’t lead to relief, then lighten up elsewhere in your schedule.

Ice. Absolutely helps with discomfort and may help with inflammation. It is a poorly vascularlized area so don’t expect miracles. In ifrst 24-48 hours ice several times a day 2-3 times of 10 minutes on with 10 minutes off. Early on in treatment, ice after all workouts even if you don’t have discomfort. You can decrease icing if all symptoms are gone.

Stretch. Oh My! Take One. This is a very touchy issue. Stretch after the initial injury is well on the way to recovery. Don’t stretch a cold muscle ever. Don’t over stretch calves because it can CAUSE tendontitis to worsen. No deep heel drops. No ballistic stretching – ever. Remember, stretching for males has been correlated with an increase in injuries! Not decrease! Also, stretching a muscle decreases strength and power output of that muscle. Anecdotally, I experience more discomfort when doing stretches. I have found that strengthening exercises are far superior (see physical therapy below).

Orthotics. I’m not an advocate of putting anything unnatural in your shoes. if the cause is due to a structural foot-plant abnormality and it can be corrected by an orthotic – this is a viable intervention. This intervention requires a diagnosis by a trained sports medicine, podiatrist, physical therapist – footstrike analysis trained specialist. These are not over the counter shoe inserts. I have my first pair of orthotics. They take some getting accustomed to. I actually believe they are helping. After four months off for my recent Achilles tendon tear, I’m now running about 15 miles a week. Anecdotally, some runners will swear by their orthotics and others will swear at them. The upside is that orthotics are at least addressing an underlying cause of tendonitis and not just symptoms. It still ends up an experiment of one.

Heel lifts. See comments above on orthotics. I don’t recommend over-the-counter heel lifts. They are not tailored to your foot. They tend to move around inside your shoe. They caused me forefoot pain after very short use. They may cause other foot-plant problems because it affects the rest of your foot and therfore will affect the entire kinetic chain up your leg. Not a good thing.

New shoes. Sometimes, worn out shoes can contribute or cause Achilles tendonitis. The rule of thumb is to replace your shoes every four months or after 400 miles of running, regardless of how they appear. They lose their protective characteristics over time. You also should be fitted for the “right” shoes for you. That means going to a running specialty store and have a foot-strike analysis done. They will advise you what “family” of shoes are best for you. Do not succumb to buying what some friend or neighbor is the “perfect running shoe”. It may be for them, and it may not be for you. There is no such thing as a single best shoe. It depends on the person.

Anti-inflammatories. Over the counter drugs, NSAIDS, are most commonly advised. Ibuprofen leads that list. In a poorly vasularized region, the amount of actual inflammation reduction may be debateable. It will reduce discomfort. But that is not necessarily a good thing. Reduced pain may lull you into thinking it’s ok to go back to training. Think again! Pain is a warning sign. It is feedback to you.

Cortisone injections. Yes, these are injection directly into the tendon. The current advice is no more than two injections into a tendon. More than that correlates to a weakening of the tendon and an increased incidence of tendon tears or ruptures. These work great in conjuction with some rest and rehab. It will all be undone if you launch back into training without treating the underlying cause of your tendonitis. This treats symtoms and does not cure tendonitis.

Immobilization. Soft casts, walking boot/casts to immobilize the ankle are often prescribed. These are better than hard casts and reduce the muscle atrophy that is associated with hard casts. The goal is to stop using the tendon to allow your body to heel itself. This may be for weeks to months. I’ve had mixed results with these having been put in them on three occasions. I found in my most recent bout that it further irritated the location of my tendon tear. I booted the boot after a few weeks and started to improve a bit after that. Constant use of the tendon, even if it’s just walking, is irritation to the tendon and prolongs recovery. So, if you are at the point of having to completely stop running, I advocate trying these out to expedite recovery.

Accupuncture & Accupressure. These do not have scientific backing as treatments. My experience was that they gave me a temporary reduction in pain symptoms. Discomfort returned within 24 hours of treatments. Save your time and money.

Massage Therapy. It feels good for sure. There is no real scientific backing for this as a treatment for tendonitis. If it feels good do it. But don’t think it’s curing your tendonitis.

Surgery. Forget it. The invasive nature of surgery and the resultant scar tissue is simply to drastic a step to take for tendonitis and even minor tears. Only in very chronic, severe and tendonitis that is unresponsive to all other treatments would surgery be considered. Unless you have a complete rupture of the tendon I do not know any doctor who would do surgery. You’ll know your tendon is ruptured by sudden weakness of lower leg, calf bunching up in a knot and substantial pain. This will require surgical repair.

Physical Therapy. In order to reduce the chance of re-injury you must address the underlying problem. If it is training – change what you are doing. However, if is is biomechanical, it won’t be corrected by changing your training. The number one predictor of injury is past history of injury. That is because we never address or remediate the underlying causes. We just jump back into training after the pain goes away. There are numerous exercises for the lower leg. They work to improve coordination, strength, balance and range of motion. Optimal exercises are one-legged to isolate each leg independently (reduces cheating on the exercises and using a stronger leg to compensate). Often a balance board is used to These exercises work all the small muscles around your ankle, lower leg, up throughand including your quads, hamstings, glutes and lower back muscle groups. None of these act in isolation.

Barefoot Running. Oh My! Take Two. The theory is that this is natural some how. Unfortunately is is not for the western world. If you read the proponents of this technique they do state that it is for completely neutral foot strike runners with no history of injuries. I don’t know too many who fit that description. There is also very poor science behind it. The dramatic drop in heel height will cause tendonitis in short fashion for anyone predisposed to it. Therefore, please do not try this. By the way, though this has resurfaced recently as some “new” and “natural” approach to running, it was advocated back in the 70s. It is just recycled. I tried it back then, duped into thinking it would help me. It did very bad things for my tendonitis.

The Strassburg Sock. This sock is designed to give a gentle stretch while at rest or even sleeping to keep your calf muscle elongated. The theory is that by elongating the muscle it will reduce tension on the tendon. The sock is used to treat plantar fasciitis, Achilles tendonitis and calf tightness. Follow the instructions carefully if you use one. I tried it. It was neither comfortable nor convenient. My Achilles tendon seemed irritated after using it. I stopped. For now I put it in the category of stretching. (See above.)

Yoga. This can help some range of motion. If done correctly and very modestly it might help balance and coordination of muscles. It does not treat, cure or prevent tendonitis. If any yoga instructor urges you to stretch further and further beyond your comfort level (it should NEVER hurt) then run as fast as you can from that location. We are not all made to be bent into pretzels. Do not think that if “they” do it, then it must be normal. It’s not. Yoga and any other similar eastern disciplines should be gradual and always within your comfort range (not someone else’s comfort range). Bottom-line – if it feels good to you go ahead and do it.

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About Dean Hebert

I’m a mental game coach, author and speaker. I work with individual athletes, parents, coaches, and teams on sports performance enhancement. Beyond my academic post-graduate work in sports psychology - the psychology behind athlete performance – I am a certified Mental Games Coaching Professional (MGCP) and certified hypnotherapist. I’ve authored several books and hundreds of articles. “Coach, I didn’t run because…” (2008) is a seriously light-hearted look at making excuses not to workout and how to overcome them. “Focus for Fitness” (2009) and “Screw the Goals Give me the Donut” (2010) are two of my eBooks on mental game approaches for the everyday athlete. I wrote these because I believe that everyone can benefit from the powerful mental techniques that the world’s best athletes use. I have been cited in Runners World, Best Health magazine (CN), SWEAT Magazine, and the Washington Examiner amongst many other publications. I have been a featured mental games coach in Runner’s World and for the internationally acclaimed trail running resource - trailrunningclub.com. I also regularly appear on sports and fitness talk shows such as LTKFitness, Runnersroundtable and for more than three years I have co-hosted a weekly video series with Coach Joe English for Running-Advice.com. I specialize in mental toughness training. My clients include tennis, synchronized swimming, golf, race-kart, soccer, motocross, volleyball, MMA, cycling (road, off-road, time-trialist), running, duathlon and triathlon, basketball, football and baseball athletes. I have coached world-class athletes and athletes internationally. I have a passion for working with youth athletes and helping them apply mental game skills and techniques to all areas of life. Most importantly, my aim is to have people enjoy sports and life to their fullest through peak performances.
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39 Responses to Achilles Tendons Treatments

  1. kleanchap says:

    I am suffering from Tendonitis in my arm. Great timing to find this informative article. I am a ruuner. Interesting that my running interest and medical problem showed up in a nice little article. Great article and great advice!

    PS – Tried Accupuncture. Just as the coach recommended, save money and time.

  2. Pingback: Treatment and Prevention For The Achilles Tendon « Track Mom.. “Everything Youth Track and Field”

  3. Jim says:

    Myofascial Release and Trigger Point Therapy are definite helpers for any kind of tendonitis. Moist Heat is also a key for rehab, not ice. I see approx. 30-40 patients a week for various forms of tendonitis. 80-90% are cured within one month as long as they are compliant with aftercare ( Moist Heat, Stretching and avoidance of aggravating behaviors or activities). Accupuncture IS shown through scientific to be effective for various pain states. Unfortunately, many that practice it are not trained well. Good Luck!!!

  4. Jim,
    Indeed with some people some of the time in some cases myofascial release may help. The research is not conclusive however. The results are equivocal. For every controlled independent study that supports it there are others that don’t. This is the case with many alternative therapies. It doesn’t mean they won’t or can’t work. But, there simply isn’t enough support for them to categorically endorse them.

    My stance is that if an individual finds that it works for them – awesome – stick with it. However, that is different than recommending something that is not shown (by controlled independent research i.e. have no stake in the outcome) to consistently work. Avoidance of aggravating behaviors is the optimal solution (unfortunately for we who want to keep doing our activity). ANY treatment combined with stopping the aggravating behavior will work.

    Many treatments offer palliative relief… they feel good so we do them. Such is the case time an time again with massage therapies (yes, i know these aren’t exactly the same as MR). Study after study show individuals say the treatment feels good. But, muscle and connective tissue are unchanged; actual performance is not improved. (That is, they say they “feel better” but cannot run or cycle well enough to indicate recovery.)

    So, I’m glad you have found compliant clients who stay away from the aggravating behaviors and enjoy your treatments. I really am glad for them that you have been effective with them. I do not disparage anything you are doing. I can only write on the predominance of research. Keep up the good work.

  5. Jim says:

    Dean,

    Unfortunately I cannot claim that my patients necessarily “enjoy” my treatments 🙂 As for staying away from aggravating behaviors, yes, while in treatment, but a number of my patients have been and are professional atheletes who go on and continue a modified regime of enhanced performance in their respective sports AFTER they have allowed themselves to heal properly. If, by your own standard, you avoided all medical treatments that are fully documented and understood by science, you would avoid approx. 40% of known modalities and drugs available. In many cases, we have no idea of how or what the mechanisms of action are. They are still accepted in medicine today however. Avoid obvious quackery, yes. Being to rigid or critical will hinder one’s growth and ultimately healing, however. Regarding the soft tissues, there is an abundance of info and research that you and your readers might find helpful. I refer you to;
    http://www.myofascialpainrelief.com/MFRresearch.html

    All the best…………………

  6. Good points Jim. Similarly, the psychological affects are poorly understood yet very real. If one believes in the treatments one is more likely to have positive results. If one does not, it is far less likely to have positive results – regardless of a well documented treatment or not.

    My comments and responses here reflect both research and my experiences. I’ve tried many non-documented treatments over the years because I happen to be very open minded and I’m willing to “try whatever works” (oh ya.. and is legal).

    Thanks for the link. Looking over some of the articles it appears that many of these articles are about case studies not research. I could go on about what makes good science but won’t.

  7. Patricia says:

    can some new running shoes cause trouble for the Achilles tendinitis? Since i had purchased the new sneakers I’ve notice the pain I have in my Achilles and I’m coming up on 3 half marathons and on full in January which they are all paid for. So is there anything I can do?

    HELP!!!

  8. Patricia – the answer is – absolutely YES! One of the first questions I ask of any runner who is experiencing ANY “new” pain, ache or discomfort is if they have changed shoes. Even the same model year to year can be changed by manufacturers so even that is no guarantee to “safe” running. Though this isn’t always the cause – it is like any good investigation – start with the obvious.

    Certainly, if removing this as an issue doesn’t resolve the pain it could be other things such as (since you are training for progressively longer races) sudden increases in mileage or quality of runs or introduction of hill training.

    So, if possible go to your former shoe – model and make. If you can’t – go to a running store (no big boxes- sorry – they do not have the expertise you need) that will put you on a treadmill and do a foot-strike analysis and put you in the right “family” of shoes for your foot-strike. It is not as simple or obvious as you might think and a professional running shoe specialist can help.

    Use anti-inflammatories as directed and tolerated. Take a few days (week) of rest. Ice after all runs until you are sure it is completely resolved. Run easy to start runs and warm up well before launching into harder/faster workouts. Be very careful on stretching at this point. The odds of making it better as as good as making it worse. Only the VERY gentlest of stretching may be done; just enough to stay loose while not running much.

    At this point I honestly would not suggest all kinds of treatments and interventions unless these basic things do not work. Then… well, read above and start trying them.

    Stay in touch – I’m always interested to see how these things progress and I always love to hear some success stories!

  9. I am a little late chiming in here, but there is research supporting the use of Myofascial Release with plantar Fasciitis. If you click on the above mentioned research link (my website): http://www.myofascialpainrelief.com/MFRresearch.html and scroll down to reference #55, you will see a research citation for:
    Effectiveness of Myofascial Release in Treatment of Plantar Fasciitis: A RCT.

    I use myofascial release daily in my practice for conditions such as plantar rfasciitis with very good results. Give it a try!

  10. Dean Hebert says:

    Walt,
    Indeed myofascial release helps some of the people some of the time with some ailments. And htat is the best that can be said about it. Jim’s comment above mentions it. The article you mention isn’t about Achilles Tenonditis (topic). As with each treatment listed above, each practitioner promotes their specialty as the “cure” and cites studies. The problem is that virtually all these studies are case studies not controlled research; furthermore they are done by people with a vested interest in the outcome. If you are a myofascial release practitioner are you going to publish something that shows it doesn’t work?

    So, they are interesting and in fact show that some people some times are aided by these treatments. The problem is that there is no single approach that works universally nor consistently otherwise this would be an easy cure. That is the underlying point of this article and thread.

    I am definitely not saying that myofascial release doesn’t work or won’t work…. it might… just as any of the other approaches may.

    For more please read my responses to Jim.

  11. Mandy says:

    I can see this site is a few years old, but I’ll try anyway. I developed Achilles tendinitis this summer after increasing my running mileage to 6 miles 3-5 times a week. Now, I have completely stopped because of the pain. However, it doesn’t hurt me to fast-walk and I have been doing it for 3 miles 4-5 times a week. This is still good exercise for me but I would like to return to running asap. Should I stop walking to allow my tendon to fully rest even thought there is no pain with walking? I can tell that my tendon is healing, but not quite 100% yet when I do a “test run” for about a block. Thanks!

    • Dean Hebert says:

      Hi Mandy,
      If I understand your situation – you still have the tendonitis even though you are only walking. It has not completely gone away. At this point if walking is irritating it, you should back off for a week or so – stop the fast walking. Be sure you are taking anti-inflammatories if you can tolerate them. Then GRADUALLY return to running. Stay away from hills and fast running. Perhaps use the alternating run-walk approach in easing back into running. If the tendonitis is still there you may have a mechanical imbalance and should see a physical therapist who specializes in runners to get specific exercises to strengthen the respective muscle groups. Ice after every workout. I found that heat BEFORE a workout helped loosen me up. Also if you do not do warm up exercises and drills before running – you may want to look into integrating these. They will both loosen you up, warm up tendons and muscles so they work more efficiently but they will also strengthen you.

      • Mandy says:

        I just wanted to let you know that after a few weeks off I am now completely healed and easing back into running. My tendon feels great but I am still very cautious for fear of re-injuring it. Thanks for your advice! It worked great!

      • Dean Hebert says:

        Love to hear that you are back! Well done! Coming back always takes patience!
        Dean

  12. Jody Thomas says:

    I also suffering from achilles tendonitis. Here is the short version of my long story:
    I’m a 45 yr old female who has been running middle distances (10k to halfs) since 1993.
    Noticed a “squeaky” tender tendon (left side) in 1999. It seemed to heal on its own after I could find no help (no Google back then :), and the ortho thought I should have my achilles reattached-yikes!). I was having some hamstring trouble (left side) that I could not work out and saw a PT in 2007. I was diagnosed with a leg length discrepancy (on the left side) and PT had me add a 1/2 inch heel lift to my shoes (I never added the lift to much besides my running shoes). I also was working to strengthen my left glute med. Tendon was just fine. In 2009 ran first half marathon in 10 years. I began noticing knee pain. With the help of the internet I self diagnosed myself as a heel striker. I’m a short girl and was told in high school track that I had to take longer strides. Hence, heel striking. In hindsight, I was probably a midfoot striker who needed some coaching on running form. Instead, I shortened my stride, forced myself to run on my toes (seriously, I tried not to let my heels touch), embraced minimalist shoes (with no ease in period-jumped right in with six mile runs) and finally broke down in May 2010. There was no pain running but always at the end of the run and now I was feeling the same thing on my right side. I had just begun working with a running coach and had improved my form, however I could not find a PT or doc that seemed to understand what was happening. Ended up with a chiropractor (a barefoot runner himself) who finally seemed to grasp my problems. With x-rays he diagnosed a 3/8 in fixed, leg length discrepancy and told me I have a very in-flexible left ankle. All running and walking was brought to a halt. I did ice baths two times a day for 20 min. When I was pain free every morning, gentle walking was introduced (in old running shoes with a full shoe lift). I was able to run again (pain free) by Jan. 2011. I found a minimalist shoe that is not aggressive and seemed to be back in business running 10ks. Then this spring (as we heated up here in the South) I had a run in with dehydration (brought on by diuretics prescribed by a dermotologist who swore they were so mild they would not be an issue to a serious runner). Opps. They were a very big issue. So I “plodded” through every run feeling as if every mile was the end of a marathon. Form went out the door as I struggled just to get through my runs. That is when the tendon “woke” back up. My running coach pressed me to strength train my running muscles. I’ve always been an athlete. Soccer, gymnastics, track, basketball, dance and pilates. I’m strong and flexible. However, maybe not in all the right areas. So I’ve jumped into single leg squats, ham curls, quad lifts, step ups and calf raises. Running has been out since late May and, walking still causes tenderness afterwards so I’ve been aqua jogging but not diligently. Now my calves are always tight due to the calf raises and both tendons are tender and stiff in the am. I’ve taken the full shoe lift out of my shoes because I just could not get good “toe off” with the stiff insert. I am still using a heel lift.
    I guess I’d love to hear your thoughts as I am at the end of my rope. I don’t care if I ever race again but I want to run healthy for years to come.

    • Dean Hebert says:

      Jody,
      Wow.
      Here is what I have learned lately. (I am always learning on this thing.) I have a physical therapist who is certified in a special program (for PTs) that focuses on runners and running related injuries.
      I stopped running for the past 3 months (completely and totally – not one step). I needed to heal and get myself in balance. That is when I started working with Nicole.
      I have done all that you mention when it comes to rehab. BUT I now have learned that sometimes it isn’t what we think it is that is the ORIGINAL cause of our tendonitis. The tendonitis may in fact just be the weak link that breaks down – as a result of other things.
      Here is what we’ve discovered with me:
      My thoracic spine (upper back) is stiff and inflexible.
      My FEET are inflexible from the big toe joint to the calcaneous.
      My hips are inflexible – abductors, adductors, all glutes, groin.

      It is NOT an issue of stretching – that is not a solution.
      But it has been an issue of dynamic range of motion for all these body areas and realigning symmetry in movement.

      I feel GREAT. I had my first run in an Alter-G treadmill last week (2 miles in 14:45 @ 81% of bodyweight). Painless.

      So, strengthening and one leg squats are only partial solutions, conventional strength training is not the answer, conventional stretching is not a solution, minimalist shoes or support shoes are not the answer, dynamic full body integrated work is the answer.

      I’ll get the name of the program and maybe find a link with graduates and do a post on it. I am sold on the holistic approach and a “cause” versus symptoms approach.

      One thing, you seem to be very active and if you are doing other activities (cross training sports or whatever) they may be continually aggravating things and inhibiting recovery. I have literally done NOTHING for 3 months. I only started going on walks in the past 2 weeks. It may sound dramatic. But I know i had just reached a breakdown point. I had to stop and let my body AND MIND recover. I couldn’t take more disappointments and false starts in my comeback. But make no mistake about it… I’m coming back!!!

  13. ivy says:

    Wow — I am so happy to have stumbled upon this! I also have a lot of hip/knee pain and lack of flexibility which I believe are a huge contributor to my achilles tendonitis (and haglund’s bump). My podiatrist has prescribed typical runner’s stretches and a night brace. But those treatments are not helping at all. My ankles hust just ANY pressure on them (lying on my back, backs of sneakers, etc.). I barely walk let alone run. Looking forward to any more insight about a holistic approach to addressing this!

    • Dean Hebert says:

      My advice is to find someone else to treat you. Those things you are currently doing are what have been prescribed for years and have had VERY mixed results at best. Read this post and find someone from the Gray Institute to treat you. http://wp.me/p4Y4V-yn

      • ivy says:

        Hi Dean — thank you so much for this advice. Unfortunately I couldn’t find a PT trained at Gray Institute near me (I called the HQ for assistance). However, you did encourage me to seek out a more holistic-oriented PT. Appreciate your blog — a wealth of information and advice here!

  14. Matt says:

    What do you think of Platelet Rich Plasma (PRP) Treatments for Achilles Tendonitis? My Orthopedist has recommended it (and mentioned all the famous athletes eg Jeter, Woods etc who have gotten it), but I’ve also read some more skeptical takes on it. Thanks!

    • Dean Hebert says:

      Matt,
      I had PRP done as part of my surgery last year. I am sold on its efficacy. The results speak for themselves. I have had 3-4 other runner here in the area who have had it done also with great results. They are all back running 100%.

  15. Dean Hebert says:

    Ivy – the answer is a resounding yes. Do it.

  16. tyrmi says:

    My impression is that very moderate exercise is the way to go when dealing with Achilles tendonitis. I didn’t get any effect out of the eccentric heel drops. I swam and walked a lot, ran a little, and then my right foot healed up nice. Doesn’t really help a professional athlete, I guess, but that’s the way it was for me. It feels like my right foot is stronger than before. Now I’m attacking the trail again, trying desperately to be just a little more patient than the last time. I should add I’m a novice runner.

    And as a barefoot/minimal-shoes runner I can say, it’s definitely more taxing on the quads and Achilles tendons. Just like rearfoot strikers are prone to shin splints and knee pain, forefoot runners seem to be prone to Achilles Tendonitis and Plantar Fasciitis, based on what people blog.

    Thank you for this (and the other) posts on this subject, good thoughts.

    • Dean Hebert says:

      Glad you dropped in. You are right about patience. It’s probably the number one lesson when dealing with Achilles. Glad yours got better and you are back out there.

  17. Janice says:

    I am desperate for some relief! I am a 50 year old female who started running last summer (2011) using the C25K program. So, I didn’t start off doing too much too soon. Eventually, I started pushing myself a little harder than the program recommended. After about 2 months of running, I started to notice a little bump on the achilles tendon area. It was a little tender but did not hurt when I ran (or after). I kept running. Finally, it became so painful that I quit, cold turkey. I tried ice, I tried PT, I have even been to an orthopedist and worn the aircast. The aircast helps during the day (I am a teacher so I am on my feet all day). However, when I get home, take off the cast and relax, the pain starts back. When I wake up in the mornings, I am in incredible pain and have to take the stairs one at a time. After trying PT and the Aircast and no exercise for over 6 months, I feel like it is worse. The mornings are horrific…I use the Strausburg sock or a night brace for plantar fascitis (switching from time to time). Nothing has helped. The last time I saw my ortho, he told me to try PT again and told me to try the Arizona boot (Seriously?…I did some research and they are like $1,000 or more….there is no way). He charged me $300 for an Aircast that you can buy on your own for any where from about $70 to $100….I am starting to think he is a quack. I don’t think he takes my pain seriously….it is intense. I am at the point that I don’t know what to do anymore. This is seriously affecting my lifestyle. Any suggestions would be appreciated! Oh, he has recommended the injections of blood into the tendon but I wasn’t sure about that. Thought maybe he was just trying to get more $ out of me. I see, above, that it is actually beneficial to some. However, my insurance does not cover it and it is $200 each time…what do you think of this?

    I am desperate and don’t know how much longer I can tolerate this without losing my mind. It is frustrating because I just want a cure and it is evident that there isn’t one, just a matter of trial and error until you find the right approach!

    Glad I found your site! Hope you have some suggestions for me.

  18. Janice says:

    Dean,
    Thank you so much for the information! I am going to check into an ASTYM center that is not too far for me…Columbia, Maryland is the closest. I may plan to do this during the summer when school is out and I can devote a few weeks to the complete treatment without the interruption and/or inconvenience of work. I may return to PT (I did have a good physical therapist and I am thinking that maybe I did not give it long enough!). I will also check into people who do PRP in my area. My orthopedist is supposed to have a background of working with some professional sports team in Texas but I just was not impressed with his very abrupt office visits and his lack of what I thought might be thorough questioning before making suggestions. He has said that it is degenerative so maybe he just thinks there isn’t much that he can do for me. I really feel like he doesn’t have a clue as to how much pain I am in or maybe he just doesn’t have time for me. As a result, I am looking around for a new orthopedist!

    I am sorry if I confused you and caused you to think that I also have plantar’s fasciitis. I couldn’t bear to have that pain as well! I wear the sock and the brace to help immobilize my foot better at night and to keep me from pointing my toes, which makes the pain much worse in the mornings and even after sitting for a while (with my toes pointed). It appears that flexing the foot helps me to avoid having more pain and stiffness.

    I am starting to wonder if maybe I just didn’t give the aircast and PT enough time and didn’t work hard enough on my own. Until summer break, when I can get to ASTYM, I think I will work with my local therapist (who said that I have some issues in my calves, quads and lower back which, like you said, may be the contributing factors.). I am saddest because I was truly enjoying running. It changed the whole way I felt about myself and about life.

    Thank you so much for taking the time to address my post. You give me some hope that I can conquer this thing and you’ve given me a renewed enthusiasm for sticking with treatment a bit longer and being dedicated to doing my part at home!

  19. Milena says:

    So Dean,
    It’s 2013, and I’m curious, has the PRP treatment worked for you? And what about the PT from the Gray’s Institue?

    I have stumbled across this site due to an Achilles tendon injury affecting my left tendon when I was in basic training for the military for 5 months. It has been a year and a half since injury, and mainly a dull pain. Now what is happening is my right tendon is really acting up, I strained it a couple of days ago and now it is extremely painful even to walk. Which is really terrible for me, as like most others I have ran a few half marathons in the past and I like to hike and salsa dance and now these things are really effected.

    I live in Canada, so not sure I can find the same two treatments that you have recommended up here 😦

    Milena

    • Dean Hebert says:

      My Achilles is 100%. I’m running again though I’ve had other minor injuries along my come back trail – mostly due to compensatory mechanisms in which I favored one side and didn’t have a symmetrical stride. So, PRP and surgery worked. Nicole from the Gray institute program now sees many of my runners and others down here and is thriving specializing in runners. Doing really good things.

      Your best bet right now is 100% rest for the right tendon… until pain is gone (no dancing no running). The left tendon is chronic and my thought is finding a PT from Gray institute AND getting some of the treatments mentioned along the way on this post. You very well could have injured the right one due to the left one because of favoring it slightly. When we compensate… the body has a way of telling us.

      Hang in there.

  20. Milena says:

    Wow Dean,
    Thanks for your reply, I was pleasantly surprised to see that you had actually replied, that is great thank you 🙂
    Yesterday I went to my chiropractor, Mike Murray, who specializes in Active Release Techniques:
    http://sportmedbc.com/practitioner/38046
    I was referred to him by a salsa dancing friend of mine.
    He put this electric pulse thing on my achilles and let it stay on for about 5 minutes, then came back in the room and turned up the electricity for another 5 minutes, and came back in the room and increased it for the third time for another 5 or so minutes. I’m not sure what treatment this is called.
    Then he used this hard metal tool thing to scrape on my achilles (This hurt verrry badly) and then massaged it with his hands and kind of pushed everything around.

    Mike believes it is actually likely my feet that are causing my achilles to be injured in the first place (even though I had not had this happen the few years previous) and I have never even had achilles pain before, my biggest symptoms from running was always really tight calve muscles because it seems I have very strong calves, especially for a female.

    In any case, I am going away on a trip to China for a month in 4 days. Mike suggested I seek accupuncture/reflexology care while I am there as it may help to increase blood flow. But I will really have to slow down on the walking and exploring that I had planned to do. (Originally was going to run the Great Wall in Beijing).

    I guess I’m wondering what the real culprit was to my injury, and how I may remedy it. Because Mike said it was my feet that was my problem, he suggested I work on strengthening my arch in my in step with these insoles that are called “Barefoot Science” where they have a 7 step progressive insert that you place in your shoe. They are 75$ and I thought I would give it a try. I don’t think I’ll ever be comfortable running barefoot, but this was his recommendation for now. He is quite swift with me in the office. I also saw a Kinesiologist for for infrared laser.

    Basically what I’m trying to say from all of this is that I may not have any luck finding one of the Gray Institute PT’s and I don’t know if the PRP procedure can be done here. I am just trying to correct this problem, so that it never develops again. I also had a massage on my calf this week post injury and the masseuse says that my pelvis was out slightly and that to correct this he suggested to work on strengthening the transverse abdominus muscles as well as the lower back muscles. I’m not sure how to strengthen those muscles but better find out somehow soon to deal with it. FYI, I am a 28 year old female.

    Anyhow thanks for reading my long story, have a great day,

    Milena

  21. Milena says:

    I’m also convinced that maybe if I lost that final 10-15 lbs then maybe it will help me with my running form? I know I was about 15 lbs lighter in 2011 when I ran my first half! Yet of course running helps one to lose weight, it encourages me to eat better for my runs and it is cardio of course.

    In any case I bought your book on “Coach I didn’t run because” … I was told by Mike my chiro that not everyone is meant for running yet in the same breath he says that we are all designed to run. So confused…Now to just break out of this self doubt that I can be athletic and get back into some kind of athletic activity…biking, etc…Running was always so fulfilling for me, always felt like I was accomplishing something and was in the best shape of my life when I was running 🙂

  22. Heidi says:

    Hi all
    The Info I have found on this thread is absolutely priceless

    I had a mild case of achilles tendonitis that was getting better pretty fast ..started stretching too soon and too frequently due to the doctor encouraging it ..4 days later I was unable to walk. I had no idea it was due to the stretching until I found this website.

    I Have a walking boot with a 3/8″ heel insert the doctor ordered for me. I am only supposed to wear the boot when going out..indoors I am not supposed to wear it.

    I just got it today but when I put it on my tendon is still so messed up that the back of the boot touching it is making it painful. Is this normal?

    I have never hurt myself before and have no idea how to handle this.

    • Dean Hebert says:

      Heidi,
      Pressure on the tendon can bother it. Put a cushion between your heel and the boot. Might need to experiment a bit with location. But, the more irritation the worse… so you do need to minimize it.
      Don’t do anything at all that irritates it … if it goes “ow” don’t do it. Period. “Ow” means you are doing more damage by irritating it.
      As for indoors outdoors… if it feels better to wear it… wear it all the time (not in bed) for a week or so then ween your way to using it outdoors only.
      Hang in there.

      • Heidi says:

        Thank you SO much for the quick reply 🙂

        When my husband got home from work he measured the heel insert which the doctor prescribed for 3/8″ . The one they put in is 3/4″ so maybe that is the problem.

        I definitely will not wear it until we get this size issue worked out and if it still hurts worse on then off I wont bother with it at all. I had high hopes for this thing because I was hoping it would get me out of the house and off the couch. I have been in with this problem for way too long.

  23. Heidi says:

    Hello Dean and anyone else reading this 🙂

    I wanted to give a quick update- since I have not progressed much in a month, we got an MRI done on my ankle. It shows a bit of tendinosis and a small tear – Doc thinks this will all heal fine in time ..so I am in a boot for at least the next 4-6 weeks..ugg

    I have gone from being at the gym 4 or 5 days a week to doing absolutely nothing for a month and its gonna be awhile longer. Its totally maddening!

    I have read (and the doc said this as well) that tendinosis can take quite a long time to heal. This whole thing has me so sad. I am so bored..what a way to spend my summer! I went from tan and feeling fit to being pale and feeling like a blob in 4 weeks..argggg

    Anyway..if you have any tips they are most welcome 🙂

    • Heidi says:

      hmm after thinking about how I have been feeling..I am wondering if the boot isnt part of the problem..I dont feel it provides enough stability which is why everytime I wear it I feel worse..a few days homebound hobbling in slippers feels better then an hour or two out in the boot..thoughts on this?

  24. Nick says:

    Last year I moved to San Francisco and started walking/running up and down the hills in bad shoes. Very quickly I developed tendonitis in both achilles. I haven’t been running, biking or hiking in a year, and I miss them terribly. But the tendonitis has improved in fits and starts. Thought I’d share my experiences:

    What helped:

    – It’s gotta be the shoes: I waited too many months to replace my daily wearer shoes with a pair of proper walking shoes. When I did, the pain immediately dropped way back. A podiatrist gave me a list of “vetted/recommended” shoes. I bought and returned several pairs from Zappos off that list until I found a pair that was comfortable. Zappos was great because I didn’t have to walk around a mall shoe-shopping and aggravate the tendons further.
    – Massage: Deep tissue massage along the tendons and calves REALLY helped me – but NOT right after the injury – only after MONTHS of healing & rest. The first massage was really painful, but within a day my ankle flexibility returned, I could walk further and flex my feet upward without pain (flexing downward still hurts). And the flexibility has persisted since then. The benefits of massage plateaued after two sessions, so I think it mainly broke up scar tissue. I would NOT try massage soon after an injury.
    – No walking barefoot. I now wear a second pair of my proper walking shoes in the house.
    – Gentle calf stretching with a towel ONLY. All other types of calf stretches made it worse. But the towel stretch often eliminates little pangs or throbbing around the tendon, which suggests the lower leg muscles are sometimes pulling on the tendon and need to be relaxed.
    – Modified driving: Pushing on the gas pedal really aggravates my right tendon. I had to limit driving, use cruise control whenever I could, and try to keep my foot relaxed while using the quad muscle to push the pedal (which is fatiguing, so I can only drive short distances).
    – Moderated icing: After the onset of tendonitis, I got in the habit of icing A LOT. But after a couple months, I think I was icing too much. It was just making my feet really stiff. So I cut back and only iced in the evening, near bedtime. That way I wasn’t walking around on stiff, freshly iced ankles during the day.
    – Arm exerciser: I bought an arm exerciser to get cardio during times when it’s too painful to walk. I have to sit on my knees to use it though – using it with feet planted engages my feet for stability and irritates the tendons. Arm exercising is a poor cardio substitute for biking, but at least it’s something.
    http://www.amazon.com/MagneTrainer-ER-Mini-Exercise-Bike-Exerciser/dp/B000V53KD8

    What hurt:

    – Heel lifts: Way too painful. They seemed to mess up the biomechanics in my feet. Proper walking shoes provided all the heel elevation I needed.
    – Insoles: A doctor recommended SuperFeet Green orthotics. I wore them for a few months with my bad, flat-soled daily shoes. I wish I hadn’t. They made the pain worse, which I discovered when I found the right shoes and ditched the SuperFeet.
    – Stretches: Deep stretching of calves made it worse.
    – Calf raises: Super painful. Every time I tried them, I set myself back.
    – Stationary bike: I was told this was an acceptable cardio substitute, but in my case the pushing action on the pedal aggravated the right tendon especially.
    – Believing that “feeling better” meant “healed”. Each time I felt free of pain, I did some ambitious exercise that brought it back. Next time I’m going to rest longer even when it doesn’t hurt.

    • Dean Hebert says:

      Nick,
      Thank you for contributing. You are experiencing the frustration and tenacious nature of achilles tendonitis. You are right – at some point more rest may be the only answer.

      I will offer that if you have not had an xray done… you might want to. My original cases lingered for years only to find out that there was no way any of those interventions would work because I had a bone spur pushing on my Achilles! THAT had to be removed before I had relief.

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