The most popular series of posts I have written relate to Achilles tendons. As a long time Achilles tendonitis sufferer I have tried numerous treatments from conservative (rest and stretching) to aggressive (PRP, surgery). Here, I have another inquiry that I thought would be good to respond to as a post with a compilation of post links at the end.
Here is Janice’s note to me (edited for length – her full comment here)
I am desperate for some relief! I am a 50 year old female who started running last summer (2011) using the C25K program.I tried ice, I tried PT, I have even been to an orthopedist and worn the aircast.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. He has recommended the injections of blood into the tendon… my insurance does not cover it. – Janice
You certainly have the signs and symptoms of chronic tendonitis. I have had it in one fashion or another for about 30 years. As you shave read in my posts I’ve tried many approaches and everyone seems to swear by their “cure”. You’e right it is frustrating. Mornings and/or days after being your feet a long time are hallmarks of Achilles tendonitis problems as is the lump on your tendon.
Let me address several points of yours. If you still have that lump, odds are that by now it is scar tissue and unlikely to go away… though POSSIBLE. It took surgery for mine to go away though I have heard others who say it went away over time. As scar tissue, it may now restrict movement of the tendon within the sheath… causing discomfort.
The fact that your doc has tried different things is ok. But, more of the same will NOT magically cure this. Immobilization has not worked.. how many more boots and casts will change that? It has been plenty long enough to prove that. I would steer clear of the Strasbourg sock – it made my Achilles FAR worse. Drop that and drop it now.. again, if it hasn’t helped yet – then more of the same won’t help it. That night brace for your fasciitis might be irritating your Achilles. Drop it. Experiment on how it feels NOT wearing and NOT doing things. There are other treatments by knowledgeable PTs for that fasciitis. Sometimes doing so many different things makes it hard to know what is causing what.
I won’t be out on a limb here by saying that you have biomechanical issues going on. The chronic fasciitis and tendonitis indicate that you are somehow making your lower leg/foot/ankle work extra hard thereby injuring it. Something is out of whack ELSEWHERE. These are only the weak link in the chain. So they hurt. All your interventions are directed at the pained area – which as I have learned – is most often not the CAUSE of the injury. It is the recipient.
The treatments that I advocate now are:
ASTM – only by a certified specialist physical therapist.
Functional PT exercises and drills for rehab – a specialist trained by the Gray Institute. (They have a completely different and holistic approach to PT work… I wouldn’t go to anyone else with running related injuries.) You need to get to the CAUSE of this and that does not mean palliative treatments for pain, discomfort or swelling. Something is wrong with your biomechanics that continues to aggravate it.
PRP injections. I had this done and I now know of other runners who have had it done (not just with Achilles). Almost everyone has reported successful results; if not cured, they all report improvement (decrease in pain and/or ability to run again).
There are many other techniques and treatment modalities. There is nothing wrong with trying them. But, these three listed appear at this time to be the best. Most others may treat minor cases or work for some people and not others. These more often work for most people (but not all).
A word about your doc. He may or may not be up with the latest on everything. Just because he’s an orthopedist or even someone who specializes in athletes does NOT mean he’s always up on what works. He may be very conservative or the opposite. He may be doing the same thing he’s done for the past 15 years or not. He may be getting kick backs from various products or drugs or not. In any case NOT all docs are created equal. If you are not pleased with him move on. Given what you have said, I would not use him for PRP. Get someone else. Ask runners in your area who have had the procedure done. Travel somewhere if you must.
You can lick this. Patience most certainly is required. Trust me. But, you can run again…
Here is a full list of my posts on Achilles Tendons related topics.
Achilles Tendon Central, Achilles Tendons Treatments, Achilles Tendonitis – Recovery and Workouts, Achilles Tendon – Comeback Case Study, How do you get fast if you have Achilles tendonitis?, 5 Top Reasons for Not Stretching Before Workouts, Diagnose and Treat Achilles Tendons , More On Achilles Tendons II, Achilles Tendon – Comeback Case Study – 6 Month Follow-Up, Achilles Tendons – Out of Shape running is Better than No Running, Trying to Out-run Achilles Tendonitis, Achilles Tendon Debridement and PRP, Debridement and PRP Report – Achilles Tendon, Achilles Tendon – PRP – Post-Surgery Update, Achilles Tendon – PRP – Post-Op Update #2, Functional Physical Therapy for Runners.