Achilles Tendonitis

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#1

Gack, I’ve got it bad. Luckily I’ve got 7 months till I start the Trail but I’ve already been in physical therapy for nearly 3 months and still keep having setbacks where I get sore again. They are working on strengthening my ankles, feet, and calves, increasing the flexibility of every joint up to my waist, lengthening my calf muscles,and increasing my proprioreception (ability to balance) as well as using ultrasound treatment on my tendons.

Anyone been through this and have a success story? I’m so discouraged and afraid my hike may be in danger if I don’t improve radically very soon.

MacGyver

#2

I have Achilles Tendonitis, and I am going through treatment too…
It was real bad before I went to the doctor.
I stretch religiously…The moment I wake up in the morning before I get out of bed, I stetch my achilles on both feet…I stretch before I hike or jog and it has made a huge difference…
I make sure during the day, I stretch where ever I can…
I found, that shoes that I used to wear, I can no longer wear them…When I do, my achilles will ache…
I tried inserts, insoles. No matter what I tried my achilles would ache and stiffen up…
So, I tried different shoes, different brands and that has made a huge difference. I can’t recommend any brands you just have to try. When I start out joggin,I make sure I take shorter steps, that helps…
Also, when I stretch, I make sure I can hold the stretch without discomfort…If it hurts, I back off…The stretch shouldn’t hurt…
My achilles is feeling so much better and yours will too…
I have been going to physical therapy for about 3.5 months…
Jeff

Jeff

#3

I had some trouble due to the back of my hiking boots pressing against the tendon with each step. Went to low cut boots and no more trouble.
Stretching several times a day helps, or whenever I feel “tight”.

Dioko

#4

I gave up hiking about 10 years ago because of recurring achilles tendonitis. I lightened my load drastically and switched to trail runners, now I can hike again. Funny thing is, the only time I’ve had problems recently is when I stretch. I heard somewhere that stretching when cold can really hurt, which is probably what I was doing. Warm up first, but if you’re getting PT, you probably know that.

Garlic

#5

I was frightened a few months before an 02 thru-hike, with extreme achilles pain. I’m a runner and it seemed like tendonitis. I was hobbled, limping and out of commission. Took a while to get the right help. Turned out to be bursitis (a fluid-filled sack that b/n the bone and the achilles) that was extremely inflamed which then put pressure on and inflamed and tightened the achilles.

Short term: (2 months) 70% relief was wonder drugs + steroids + physical therapy. This calmed everything down. Still had some re-occuring inflamation (and mild panic) going thru GA&NC. Long term prevention: With trial & error, for me, sneakers 1/2 size up laced loose-ish. Superfeet lifts achilles out of pressure area.

Probably not the same problem but regardless, hopefully some encourageement.

Best of luck.

Bearded Monkey

#6

I don’t have Achilles tendonitis…but I do have Plantars fasciitis (sp?) and I’ve had it for many years. It has limited my hiking, sometimes halting it altogether. Two widely spaced visits to podiatrists (10 years apart)resulted in widely different results: the first, where the Dr taped up my arches, worked quite well and gave me back pain free feet for almost 8 years. But the second, where the Dr used the same treatment was a complete failure.

Then I tried using Tumeric (95% Curcumin)and it worked WONDERFULLY! I started out with a “loading” does of 6 capsules a day, 2 with each meal, for 2 days. Then I went to 4 per day for 2 weeks, then I went on a maintenance dose for 4 months.

I am now pain free in my feet. My feet do ache some after hiking but at this point I’m attributing that to my walking normally after so many years of babying my painful feet and my feet haven’t gotten used to that yet.

And yes, I tried stretching and all that and none of it worked. As a poster above mentioned, stretching when your muscles are cold can be counter-productive and, in fact, I can’t do it with cold muscles or I risk getting a “charlie horse” in my calf.

Turmeric is a known anti-inflammatory and the actual active ingredient is Curcumin. If your problem is inflammatory in nature and you can tolerate Turmeric (some people can’t, but taking it with meals might help) be sure you get capsules that say at least 95% Curcumin.

Doggone/GA

#7

Sorry! I left something out. The maintenance does I took was 2 capsules per day.

Now I just take Turmeric as a precaution before I hike and afterwards. I probably don’t really need to, but it doesn’t hurt anything and if it keeps me hiking, what the heck!

Doggone/GA

#8

This problem took me off the trail during my '02 thru attempt. The best advice I got was simply to leave it alone and stay off it as much as possible for 2 weeks. Certainly no extended walking and absolutely no stretching!
It will also help speed recovery if you use alternating cold and hot therapy - cold to reduce internal swelling and heat to increase nutrient rich blood flow to the area.
This regimen cured the immediate problem for me. To prevent injury I learned to properly stretch my calf AND hamstring muscles. Achilles injuries typically occur while walking uphill. For that reason it’s important that you stretch calfs and hamstrings after a long downhill because walking downhill relaxes those muscles and makes them prone to injury the minute you start going up. This practice worked well for me and I’ve never had another episode. Keep in mind that while stretching the backs of your legs (calf and hamstring) it’s very important that you also stretch the front (shin and thigh) in order to prevent injury to the reciprocal muscles during long downhills. I learned this lesson the hard way. Hope this info helps.

Zachsdad

#9

I’m sure someone has told you, but no one above mentioned the topic of heal inserts. I was a long distance runner for 20 years and always suffered from Achilles Tendonitis. Someone mentioned Spenco heal inserts to me 15 years ago so I tried them. It was like having two new legs instantly! The heal inserts take a lot of pressure off your AT. I still wear them today.

Ned the Fed

#10

MacGyver,

I hate to sound like a broken record, but i feel your solution may be the same as I recommended for Steady On’s rotator cuff tear. That is prolotherapy. I swear by it. I had very good results with it for a back injury.

"Prolotherapy is a simple, natural technique that stimulates the body to repair the painful area when the natural healing process needs a little assistance. Notice I said “a little assistance”. Because often, that’s all the body needs, the rest it can take care of on it’s own. In most cases, commonly prescribed anti-inflammatory medications and more drastic measures like surgery and joint replacement may not help, and often hinder or even prevent the healing process.

The basic mechanism of Prolotherapy is simple. A substance is injected into the affected ligaments or tendons, which leads to local inflammation. The localized inflammation triggers a wound healing cascade, resulting in the deposition of new collagen, the material that ligaments and tendons are made of. New collagen shrinks as it matures. The shrinking collagen tightens the ligament that was injected and makes it stronger. Prolotherapy has the potential of being 100 percent effective at eliminating and chronic pain due to ligament and tendon weakness, but depends upon the technique of the individual Prolotherapist. The most important aspect is injecting enough of the solution into the injured and weakened area. If this is done, the likelihood of success is excellent."

The key is finding a well trained prolotherapist. I saw Dr. Hauser in Chicago. He is one of the best in the country.

Dr. Hauser’s Achilles Tendon web link

http://www.prolotherapy.org/article.asp?prolotherapy=229

I have don’t have any personal gain in spreading the word about prolotherapy. It just worked for me when everything else did not. If you research it, it will make sense. I think more people should know about it, it actually been around for a long time.

Good Luck.

The thru-hiker formerly known as Jeff

#11

After reading everyone’s responses I thought I should make few more comments.

No amount of physical therapy will strengthen ligaments and tendons, just not enough blood supply. It will strengthen the muscles around a joint, which is important though.

Don’t take anti-inflammatories. Inflammation is part of the healing process. Stop the inflammation, you stop the healing. That what prolotherapy does, causes an injury which your body heals during the inflammation process. When I got proloed (which is not exactly fun or pain free), I could not take advil or ibuprofen, but I could take all the extra strength tylenol I wanted. It’s not an anti inflammatory.

Dont take steroids or cortisone. You can read about it at Dr. Hauser’s web site. Actually causes damage.

Doggone/GA check out the following prolotherapy link for your
Plantar Fasciitis
http://www.prolonews.com/plantar_fasciitis_blog.htm

Garlic, when you stretch , you stretch that tendon. The greatest concentration of nerves are located in ligaments and tendons where they attach to bone. If your ligaments or tendons are lax, when you stretch, you trigger those nerves.

Good luck

The thru hiker formarly known as Jeff

#12

Wet heat is the best for loosing up muscles and tendons, at the PT, parafin dips are a tool they use to loosen up tendons before they start to work them for you, slow is the key, bonceing in a no no, if you don’t push too hard, you start to trust the stretch, and relax more in the stretch, push it hard and you may get it to move farther, but the pain will make you add more resistance against it,counter productive… there are fine lines, only you will be able to know those lines, trust what you are feeling and tell them in detail, this will greatly help your PT. As I wrote in your guest book, KM is a great product to help the healing… I helped me so much, I was able to discontinue steriod shots every three months… Wish you the best…Crawl

Crawl

#13

This is from my personal experience: Heel inserts lift the heel and thus change the angle of the foot to the leg during walking. This reduces the pull of the calf muscle on the achilles tendon and immediately reduces stress on the tendon. As a result, pain goes away. For most people, this is an effective short term fix. But beware! This is not something you want to do during an exteded hike. Lifting the heel changes biomechanics and can cause other problems. 1)Taking stress off the achilles tendon and calf muscles ADDS stress to the muscles and tendons on the front of the lower leg, leading to severe shin splints and tendonitis in the lower shin. 2) Lifting the heel also places added pressure on the balls of the feet (think - women in high heels). Do this for 15 miles per day for a week and you risk permanent damage to the metatarsal heads and joints. Very painful!

Zachsdad

#14

I hurt my Achilles tendon in 2000 and again in 2003. The problem has morphed from Achilles tendinitis to Achilles tendinosis. I have been struggling with it for 8 years now. Fortunately, it is very mild. I’ve been able to run for almost 40 minutes at a 8:30 per mile pace without aggravating it. Also, to hike 17 to 19 miles in a day. However, it refuses to heal up completely and go away. What I have found over the years is that the standard stretching exercises (the famous heel cord stretch against a wall) invariably make it worse. The condition improves when I refrain from stretching. When I stretch, it feels better for the rest of the day, but over the course of several days (with continued stretching) the tendon begins to hurt a lot more when I run. The eccentric stretching exercise you may have read about, however, definitely helped it up to a point. This is where you are up on the toes of the affected leg and gradually lower your heel (which is hanging over a stair).

Mark

#15

Mark, does the problem persist even if you stretch your hamstrings in addition to stretching you calfs?

Zachsdad

#16

“Don’t take anti-inflammatories”

In theory…I don’t disagree. BUT…when you have an inflammatory process that lasts for 10 YEARS or more, your body is NOT healing itself. At BEST you are in a “steady state” situation, where it’s not getting worse but it’s not getting better.

That’s what the turmeric helped ME with. A long-standing, steady state of inflammation. I’m not going to argue with the results. I was in pain before, I am not in pain now.

I don’t say it will help everyone, but it did help me when even a podiatrist couldn’t.

Doggone/GA