Insertional Achilles Tendonitis, Oh My!

C

Capps

New User
Cindysphinx said:
I get the MRI results tomorrow. Smart money predicts the result will be, "Your MRI shows you have insertional achilles tendonitis."

So no one has any experience with PRP, huh?

Well, it's been a month of no tennis. I am definitely going to wait this out. I feel like I have a month of rest "invested," so no way I am going to squander it by playing before this is fixed.

The last time I needed a long layoff I worked on my serve, which paid off handsomely. Maybe some 30-minute lessons on serving and some practice will take my mind off of things . . .
Click to expand...
Cindy. Got prp 1 wk ago. I will keep u posted on how it goes but so far so good. I don't see how u can go wrong with it. Very few published side effects or safety issues. At the very least it will force y to take some time off
 
T

Torres

Banned
I still say that you should be doing eccentric achilles exercises. All you need is a step, and 10 mins a day for 12 weeks so that the tendon fibres can remodel themselves.
 
WildVolley

WildVolley

Legend
Cindysphinx said:
Here's the weird thing:

I can walk just fine barefoot. But if I put on a pair of ballet flats, it flares up immediately.

Why would that be? If the reason it feels better is that I have raised my heel in relation to my toes, shouldn't it kill me to walk barefoot?
Click to expand...

The heel isn't the only issue. Squeezing the toes together can have a negative impact on the gate and the muscularity/fascia from the foot thru the calves. So that's something to test. Going barefoot allows the toes to spread, but some flats don't.
 
danbrenner

danbrenner

Legend
Hi. So i have had to sit out a week of tennis recently, when i experienced achilles soreness/tendonitis. not sure which one to be honest. Just that aching feeling at the achilles area parallel to the ankle. So that being said, i went to Sports Authority and picked out the achilles brace. It works but its not perfect. Then i had the urge to go back and try on every ankle brace in the shop. I finally found the holy grail of supports. The McDavid ankle strap. MCDAVID Level 2 Ankle Support w/ 
figure-8 straps
432R
From $24.99
This is the single best ankle/achilles solver i have ever tried on. I played some great tennis tonight with this bad boy on. It is the next best thing to taping your foot and ankle up with several layers of that stretchy medical tape. And it takes seconds to administer. Trust me this thing rocks. Please, if you are in pain, try this bad boy on and get back to me, and thank me. Or publicly trash me if it does not work for you. But either way, please try it if you are having pains. Thanks, Dan.
 
danbrenner

danbrenner

Legend
Just to add to my last post. For the heck of it, i bought ace bandages, and wrapped up my ankle and achilles. the brace i have mentioned in my earlier post is way better, easier to put on, and way more effective for achilles/ankle pains. Just buy it. The exact one i mentioned. :)
 
S

Say Chi Sin Lo

G.O.A.T.
I'll share:

From last October (2012) to about August (2013), my left heel was absolutely killing me. The funny thing was, it didn't bother me when I'm on the court. The pain and discomfort came during the aftermath. And so, I'd go home and go through the most religious icing routine.

During that episode, I took an entire December off, and 1st half of January (a good ~6weeks total) off. I thought the time off would suffice. I came back towards the end of January and the post-play discomfort resurfaced. Once again, on-court performance was unaffected.

So I bought an ankle sleeve to help me protect the back of my heel against my shoe.

http://www.tennis-warehouse.com/Pro-Tec_Gel_Force_Ankle_Support/descpagePROTEC-PGFAS.html

It actually alleviated the post-play discomfort significantly (though it wasn't completely gone). Because I never saw any detrimental effects with my on-court performance as far as explosiveness and stamina, I kept playing with that brace on.

Fast forward to this August, the brace fell apart and I stopped wearing it. For reasons beyond me, the post-play heel discomfort has largely vanished. It's weird, because I haven't done anything outside of wearing the brace for ~half a year, and come home to a religious icing routine.

I think this past year is just an anomaly for me. Since my shoulder surgeries, I've been largely bullet proof. But this past year, especially during the summer times. My lower back flared up more than once.

Anyways, now that we're in October, I've somehow played myself out of all of my aches and pains over the year. But, I'll continue my yearly routine of taking December off to rest/recover from any minor injuries I've accumulated over the course of the year, and get my mind out of tennis. Besides, December in San Francisco is usually a wash anyways.

I'm 28, so this past year of persistent pain (heel and lower back) was an anomaly to me.
 
S

Say Chi Sin Lo

G.O.A.T.
Now that my injuries are past me, I don't want to deal with this in the future. So I decided to do a lot of barefoot beach running. It seems to be helping. My usually beach run is 4 -5 miles. I don't go above 5 because I feel like that's the point of diminishing return for me.

Mind you, the first few times I did barefoot beach running, the next day I woke up and I was like: "WTF did I do to my legs?!"
 
Cindysphinx

Cindysphinx

G.O.A.T.
Torres said:
I still say that you should be doing eccentric achilles exercises. All you need is a step, and 10 mins a day for 12 weeks so that the tendon fibres can remodel themselves.
Click to expand...

I tried that. It didn't help for me. I mean, it helped a little at first, but then not so much.

I might return to this exercise now that things are feeling better.

Also, I have been doing one other thing that may be helping and may explain the issues with ballet flats.

I have been taking my shoes to the local cobbler and having them stretched. I think the ballet flats (and every other shoe I wear) are pushing against the heel spurs in the back, just enough to keep things irritated. That would explain why barefoot doesn't hurt.

I guess my feet grew or something.
 
T

Torres

Banned
Cindysphinx said:
I tried that. It didn't help for me. I mean, it helped a little at first, but then not so much.
Click to expand...

You need to be doing it for at least 3 months because that's how long (according to the studies) it typically takes for tendon fibres to properly repair and remodel themselves. At least 3x15 reps, twice a day, with the emphasis on the eccentric part - that's the part where you're lowering weight, not lifting weight, as you probably know. You don't want to be using the injured foot during the lifting phase. It also stretches the gastroc and soleus muscle which is also good for the calf and tendon in the long run. As the exercise progresses over time and assuming you're not getting pain, you need to be added weight eg. dumbells in a backpack etc to further strengthen the tendon. These exercises need to be done properly to have a meaningful effect.
 
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P

Posture Guy

Professional
Torres with another strong post. Yep, tendons take some time to remodel, no doubt.

And even after the rehab itself is complete, these are very useful for maintaining function, especially after a run or match. Studies are starting to show that eccentric loading of any tissue is a very effective way of restoring normal length/tension and function after physical activity.

For example, on another thread I posted about a shoulder workout program called Crossover Symmetry. I talked at length with the guy who developed it and we discussed the studies used to create their protocol. Based on his advice, before I play tennis I'll do one set of each exercise focusing on the concentric phase of the demand, but doing both. Then after tennis I'll do another set of each, focusing on really slowing down through the eccentric phase. And wow, it works.

Eccentric loading done properly over an extended period of time does some very interesting and useful things.
 
danbrenner

danbrenner

Legend
Hey Posture Guy. so did you get the brace yet? the only minor challenge is to not get flustered from the extra material under your arch due to the brace. Its minimal, and you will forget about it after ten minutes. So dont let that bother you at all. But get it already, so you can help others out. And on a different note. how are you liking your V 1 pro? I use the V 1 classic as one of my axes, and i love it. I have Cyclone Tour 17 anthracite at 55..
 
P

Posture Guy

Professional
danbrenner.......no, I was just curious for reference in case either I or one of my clients need one. Right now my ankle and achilles is fine. One area of my body I've never had an issue with.

And loving the V1 Pro. Just a great stick.
 
danbrenner

danbrenner

Legend
Cindysphinx said:
I tried that. It didn't help for me. I mean, it helped a little at first, but then not so much.

I might return to this exercise now that things are feeling better.

Also, I have been doing one other thing that may be helping and may explain the issues with ballet flats.

I have been taking my shoes to the local cobbler and having them stretched. I think the ballet flats (and every other shoe I wear) are pushing against the heel spurs in the back, just enough to keep things irritated. That would explain why barefoot doesn't hurt.

I guess my feet grew or something.
Click to expand...

Cindy! If you are still having achilles related issues, please check out my earlier posts, and buy the brace i have spoken about. The support will make you feel whole.
 
C

Chas Tennis

G.O.A.T.
Cindysphinx said:
...................................................
Also, I have been doing one other thing that may be helping and may explain the issues with ballet flats.

I have been taking my shoes to the local cobbler and having them stretched. I think the ballet flats (and every other shoe I wear) are pushing against the heel spurs in the back, just enough to keep things irritated. That would explain why barefoot doesn't hurt.

I guess my feet grew or something.
Click to expand...

This article, under Insertional Tendinitis, has some information on things pressing on sensitive attachment areas. It also says that some manufacturers have changed shoe designs there and it could be an issue. ?

http://www.takethemagicstep.com/coa...management/managing-achilles-tendon-injuries/

"The final consideration in treating insertional Achilles tendinitis relates to the forward pitch of the running shoe’s heel counter. (This is the back upper portion of the shoe that touches the Achilles tendon.) Over the past few years, for no clear reason, many running shoe manufacturers have added a forward angulation to the upper portion of the heel counter that causes it to project directly into the Achilles tendon. This addition often pushes directly into the back of the Achilles insertion, causing chronic inflammation, particularly if a Haglund’s deformity is present."

Foot/shoe size? Search: shoe size foot dimensions for sites on how to measure your foot & shoe sizes accurately. I found shoe size websites after my feet increased shoe size for the second time.
 
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Cindysphinx

Cindysphinx

G.O.A.T.
Torres said:
You need to be doing it for at least 3 months because that's how long (according to the studies) it typically takes for tendon fibres to properly repair and remodel themselves. At least 3x15 reps, twice a day, with the emphasis on the eccentric part - that's the part where you're lowering weight, not lifting weight, as you probably know. You don't want to be using the injured foot during the lifting phase. It also stretches the gastroc and soleus muscle which is also good for the calf and tendon in the long run. As the exercise progresses over time and assuming you're not getting pain, you need to be added weight eg. dumbells in a backpack etc to further strengthen the tendon. These exercises need to be done properly to have a meaningful effect.
Click to expand...

I might do that. I might.

See, I was doing those exercises, and I reached a point where they weren't helping. So I stopped.

Now I am doing other things that are slowly, slowly working. I feel like I have found the magic formula. That is why I don't want to change anything now.

Also, I don't fully understand. I have insertional achilles tendonitis. The problem, as I understand it, is that the area where the achilles goes into the heel is irritated. The achilles itself has no tears (according to MRI) or problems that I can detect. So what exactly would I be strengthening with these exercises that repair fibers? There was never any sort of torn fiber.

I think when I was doing the eccentric exercises, I was simply yanking on the irritated area where the bone spurs are. I think that is also part of the reason that stretching didn't help. The foam roller seems to be relaxing my calf muscle without the yanking. I feel a little reluctant to add the achilles strengthening exercises at this point (if ever).

What am I missing here?

BTW, today I "sprinted" on my toes for the first time since this problem started. That's huge progress!
 
Raul_SJ

Raul_SJ

G.O.A.T.
Cindysphinx said:
Also, I don't fully understand. I have insertional achilles tendonitis. The problem, as I understand it, is that the area where the achilles goes into the heel is irritated. The achilles itself has no tears (according to MRI) or problems that I can detect. So what exactly would I be strengthening with these exercises that repair fibers? There was never any sort of torn fiber.
Click to expand...

Doesn't an achilles tendonitis diagnosis imply damage to the achilles tendon fibers?

But since you state there is no evidence of tendon damage, I don't think it is insertional achilles tendonitis

I was diagnosed with "retro-calcaneal bursitis" -- inflammation of the bursa where the achilles tendon inserts into the back of the heel bone -- but no problem with achilles tendonitis (although the 2 conditions can often occur together.)

Is it possible that you have retro-calcaneal bursitis or something else besides insertional achilles tendonitis?



http://www.aofas.org/footcaremd/con...le/Pages/Insertional-Achilles-Tendinitis.aspx

Insertional Achilles Tendinitis


What is it?

This is a degeneration of the fibers of the Achilles tendon directly at its insertion into the heel bone. It may be associated with inflammation of a (retrocalcaneal) bursa or tendon sheath in the same area.
​
 
Cindysphinx

Cindysphinx

G.O.A.T.
^Oh, gosh. I figured it was insertional achilles tendonitis because a sports podiatrist and an orthopedic surgeon said so.

Is there "damage" to the tendon? I suppose so. Would this get better with certain stretches and exercises like the ones advocated? Maybe. But after *months* of doing what was recommended in the way of ice, stretching, rest, exercises, I wasn't making much headway.

The things that I am doing now are working, and I am not sure that many experts recommend the foam roller. It is working for me, so I kind of want to stick with it rather than start back to doing the exercises that didn't help much.
 
Raul_SJ

Raul_SJ

G.O.A.T.
Do you feel pain when you press against the achilles tendon where it inserts into the heel bone?

I just feel pain on the heel bone but not on the achilles tendon itself.
 
P

Posture Guy

Professional
bottom line, for all the "shoulds", pretty is as pretty does. If your issue is resolving, keep on doing what you're doing. Hope you're back on the court pain free very soon.
 
R

RogueFLIP

Professional
Soft tissue work for the win! lol

Eh, don't worry about what labels (diagnosis) people want to give you.

MRI's don't show the whole picture....

Sometimes, yeah stretching isn't helpful at certain stages.....

It's like if you have a knot in the middle of a piece of rope, all you're doing by stretching the ends of the rope is making the knot tighter.

But as long as you don't force anything and listen to your body, you won't injure yourself.

Glad to hear you're feeling better.
 
Venetian

Venetian

Professional
Cindy, I have another foot injury that I've posted about, but I also developed insertional achilles tendonitis last summer while trying to get back into running. It might not be what you want to hear, but I basically got really frustrated and stopped doing pretty much anything physical for about 9 months. It took that entire 9 months to heal (I know because I would test things out with a very short very light jog every so often), but now I no longer have any heal pain when running. I still have the other injury, but that's a more serious and long term issue.
 
Cindysphinx

Cindysphinx

G.O.A.T.
Venetian said:
Cindy, I have another foot injury that I've posted about, but I also developed insertional achilles tendonitis last summer while trying to get back into running. It might not be what you want to hear, but I basically got really frustrated and stopped doing pretty much anything physical for about 9 months. It took that entire 9 months to heal (I know because I would test things out with a very short very light jog every so often), but now I no longer have any heal pain when running. I still have the other injury, but that's a more serious and long term issue.
Click to expand...

You know, when I first started having the pain, I went to a sports podiatrist. He said my case wasn't too bad. He said I would probably be able to run straight ahead without much difficulty, but the starts and stops and movements of tennis would probably be very hard and cause a lot of pain.

Throughout this whole thing, tennis hasn't been a problem. Granted, I play only doubles, but I do occasionally do hitting sessions, and the movement doesn't hurt.

What is a problem is running in a straight line for more than a few minutes. That doesn't make sense to me, but there you have it.
 
C

Chas Tennis

G.O.A.T.
Have you measured your feet for your proper shoe size recently? My foot size changed and caused foot pain.

Stand on a piece of paper and outline your foot with a pencil.
https://www.google.com/search?clien...&biw=995&bih=606&q=foot measurement shoe size

At some point in the last 5 years I even had what I thought was the start of Achilles insertional tendinitis. But now I don't know when that was relative to the unexpected change in my shoe size. ??
 
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