How Do I Heal a Chronic Achilles Issue ?

"rest and do nothing is not really an option"

Unless you have permanently done physical damage, then rest is the only feasible option. Give it time to heal. Then work on the preventative measures. You don't want to push it to the point of serious damage.

You need to head to the podiatrist. The foot and ankle is one of the most complicated areas of the body and without x-rays and expert judgement you'll never know exactly what the culprit is out of the dozens of possibilities. Also, you can let them know that staying off of it is not an option, and they can advise on ways to manage it. You'd be amazed what a good podiatrist can do with a roll of tape – truly an artform.

Take a trip, it's worth the copay. Even if you don't go through with prescribed treatment, knowing exactly what's causing the problem can help tremendously.

One possibility is that the lower drop shoes are causing you to push off from the ball of your foot more, or just striking more forefoot than what your tendon has adapted to.

art~
i'm inspired and somewhat obliged i feel, to assist in your quandry.
honestly, i find more and more that i've needed to become self-reliant when it comes to medical matters, for my experiences have been rather, uhum…poor.
that's NOT to say i haven't had positive outcomes. i certainly have.
i too have done my share of homework. and even more of doctor musical chairs.
the best advice i can give is to skip the podiatrist.
unless you need him/her to catapult you to a higher qualified specialist (sports med. guru or exercise physiologist), then save your loot. podiatrists (again my experience) are for hammertoes, bunions and foot warts. honestly.
seems to me you've a biomechanical issue that continues to fuel your chronic outcomes. have you had your gait assessed? practice yoga? (i too forgot how vitally necessary yoga is to both prevention and treatment of injuries). use a foot ball or regularly practice exercises to help strengthen the muscles in that area? which brings me to physical therapy…what measures are being taken to assess the "why"?
meanwhile, have you considered inviting new activities into your regime?
cycling? swimming?
eeeks-running wrecks your body!
perhaps this is a signal you need to reduce your mileage and/or frequency of your runs, or find a new surface to run on that better supports your physiology.
and the internet has it's place. used wisely, consider it a resource of sorts to better expand/assimilate your own knowledge-base.
good luck.
lt

"podiatrists (again my experience) are for hammertoes, bunions and foot warts. honestly."

I'm sorry you've had such bad experiences with podiatrists that leads you to think they're so limited. I've had three serious foot/ankle issues.
-Overpronation
-sesmoiditis
-metatarsocunieform joint pain

for those three issues I've gone to podiatrists and have been successfully treated without surgery, medications, or other invasive techniques. for each issue it's been as simple as a quick x-ray to make sure there isn't something seriously wrong (like a bone spur), a quick tape job to try for a few days to make sure a hypothesis is correct, and then modification of a cost-effective insole to fix the issues.

For all three issues in the last four years I've spent a total of $100 on copays and insoles. I can now run farther than 2 miles at a time (a first since I was a kid), hike more than 8 miles in a day, and feel no pain while doing it. Money well spent I'd say.

Ultimately things like yoga and differentiation of your exercise might fix it, but until you've got an x-ray and a professional examination as to what the problem is, you're just playing a guessing game. (especially with feet, hands, and the spine)

See a podiatrist especially if you think there's imminent rupture but both military and civilian podiatrists (long term) haven't really done much for me. Short term, yes, they will relieve the pain but are you prepared to modify the activity you enjoy? Listening to your own feet limitations may be the only long-term solution.

I guess I'm just biased towards going to a doctor. I had to quit sports as a teenager due to my overpronation. Coaches and people told me I just had shin splints and had to run through them. Had I just gone to a doctor instead of relying on non-qualified people to give me advice, I coulda gotten a pair of $30 insoles and kept on running.

I guess that's my core point – don't ask people who don't know any better than you. Ask someone who's at least got something showing they have a clue.

nm

+1 on a doctor, and a good physical therapist. I had one Achilles give me a bad time and it took a long time to heal. Don't mess around with it!

I've had problems with my achilles tendon for more than a dozen years, beginning during six months of hiking in Alaska, a chronic problem with acute episodes. I have been to my doctor repeatedly, podiatrists, orthopedic surgeons, and physical therapists, all through Harvard health plans, so seeing some of the best in the world. I have had xrays and MRIs done. After an acute episode in December, when the pain was so severe my longest walk each week was down the aisle at the supermarket hobbling like an elderly man, I am feeling very good and did some serious winter ascents by late January.

Achilles tendonitis can take take months to properly heal. Oft times, three or four weeks of limited physical activity is essential to get the healing process going. This does not mean you can't exercise, but does mean giving up anything that will keep the sprained or slightly torn tendon from constantly re-aggravating itself. Cortizone shots can also be very helpful, but have very serious limitations. This winter I was surprised at how much snowshoeing and xc skiing I could do and how aggressively without causing the tendon to relapse. Biking, which I also do pretty aggressively, also seems OK. And once things feel good and my legs are strong, its back up the mountains.

If you haven't already, you should see your doctor. I have been very impressed with what good physical therapists can do–look for one that specializes in sports injuries. I have gone as often as three times a week during acute episodes, always with good if sometimes slow progress. The most lasting good advice from my multiple consultations with orthopedic surgeons was to wear very comfortable shoes(back then Rocksports were the only shoes they could advise me to wear, now there are many well-designed brands for people with foot-related issues.) with good heel support and, most importantly, to use high quality insoles in every piece of footwear, including slippers, and don't walk around without supportive footwear on. I have been using Superfeet with great success for over ten years now.

Good luck. The feeling of pain and the loss of mobility really suck. But it should pass with proper treatment.

"oddly enough, I think it was started by a few long runs last year with lower drop shoes than I am used to."

Any major change, done with major exertion, can have disastrous effects. Change to a low drop heel from your regular shoes, then doing several major runs in them was a great recipe for Achilles tendinitis. Once injured, it will flare up again until it's fully healed.

Nick is right: Rest is what you need. Perhaps for as much as six months or more.

Once you begin again, make any change gradual. Don't do a major run in [whatever] until you've accustomed your feet and legs to them. Gradual change is key.

But for now, rest. Rest until the pain no longer flares up. It took a year for my plantar facsiatis (sp?) to heal. Rest.

I need to first preface by saying that I am in no way a doctor of any kind, I'm just sharing the process that worked for me when I had achilles tendonitis.

Back when I started college, I ran cross country and track for a top division 1 school. The mileage was a lot higher than I was used to, and by January I had a had a case of tendonitis in my left achilles. My coach had me try various stretching techniques, icing, STEM, and ultrasound, but I just wasn't able to kick it. We eventually figured out a plan that got me back on my feet extraordinarily quickly:

1. Deep tissue massage. In my case, my achilles tendonitis was due to chronically tight calf muscles. After a half hour torture session from a linebacker-sized guy fitting his fist into my hamstrings and working the knots out of my calf muscles, my legs were noticeably more relaxed, thus putting less stress on the achilles.

2. A strict icing regimen. This is the key. I am NOT just talking about ice packs here. Fortunately, I had the luxury of a well outfitted training room, but it's still something you can do it home. You need to get a 50 gallon trash can, fill it with water, and then fill the top 12 inches or so with ice. Stand in it for about 10-15 minutes. The first couple minutes will be excruciating, but you'll go numb and can read a book or something. The goal is get the ENTIRE leg cold and flushed of blood, not just just the achilles region. I did this both before and after physical activity, but I always made sure to warm up my legs again completely in a warm bath before going out running.

3. Decrease the intensity of your physical activity. Sorry. You have to. It'll be worth it once you put the tendonitis behind you.

As always, YMMV. Just my personal experience.

on an altogether different, but somewhat relevant note…
i'm presently reading 'practical applications in sports nutrition'.
it provides me some deep insight as to the human body and the ways food can help heal. personally, i'm making a point to brew a ton of loose-leaf teas — various combos of the following: oatsraw, nettle, mate, green, hibiscus, and broth soups made from various seagreens (kelp, hiziki, kombu, wakame) and supergreens (cholrella, spirulina. wheatgrass), as all are incredibly vit/mineral rich! super nourishing and historically proven to tame/treat inflammation. amp up your omegas too and yup, all is nothing sans proper rest as all have previously stated! think synergistically.
lt

Look up eccentric heel raises. Often Achilles issues are calf muscle issues.

Eccentric heal raises helped me a lot

I perfer physical therapy over podietry because physicl they generally tries to strengthen or stretch to correct muscle weakness or imbalance whereas a a podiatrist seems to correct problems by providing more support which while treating the problem doesnt solve the underlying condition. This way you are always dependant on inserts.

The other thing that has help me is foam rolling my calves. It is essebtially deep tissue massage done by yourself. Strengthening and keeping my calves loose has solved all of my ankle foot issues

Art- this not certainly not a "cure", but proper taping helped me get through my achilles problem

Mike

Art,

I am an avid racquetball player and tore my Achilles playing the young “bucks”. My wife hid my racquetball gear for 4 months and I completely healed from the rest. I too had great success with hot and cold treatments.

FDA WARNING! The FDA has been adding warnings that Fluoroquinolones (Cipro, Levaquin) and other commonly prescribed antibiotics may cause Achilles tendon damage. I was taking Levaquin when I injured my Achilles playing racquetball. These heavy duty antibiotics take many weeks to leave the body.

Bill

As a PT I have to admit that I'm not a big fan of podiatrists either (sorry…). They like to inject tendons (don't ever, ever do that) and take X-rays and give you orthotics. All those things make money but don't really solve the problem. Injections actually damage the tendon and those who get injections actually do worse in the long run than people who sat around and watched Oprah. X-rays don't help either – a bone spur is how your body deals with excessive stress on tendon – it is a SYMPTOM, not the cause – you still need to figure out why your foot is moving in stressful ways (which you cannot see on an X-ray). And while orthotics are necessary for some people, they are way, way overused.

Eccentric training (as the previous poster mentioned) has some very good studies behind it – and you can do it at home for free. You may want to have a PT look at your foot/ankle to see why you may have the problem in the first place (which an X-ray will not show), but to deal with the chronic tendinopathy now you can start the eccentrics. Stand on a step on the toes of your bad foot, then slowly lower yourself down. Use your good foot to lift yourself back up and place your bad foot in that same position again (do NOT use your painful foot to lift yourself back up). Repeat 3 sets of 15 4-6 times a day. It will hurt…it's kind of supposed to (think about a 6/10 on the pain scale). And when it doesn't hurt to do this exercise, put a pack on with some weight in it and do it some more.

I'm not in any medical field, but I had a minor tear in 1 ankle and tendonitis in the other after a grueling hike last summer. After speaking with multiple doctors and personal observation, full isolation was the only way I could get mine to recover. Once all the pain is gone and the grinding/sliding tendon feeling is gone, which I think i disliked worse than the actual pain, thoughtful stretching, insoles, and therapy helped. Until you get the tendon to completely heal, it's just a losing uphill battle. There's just too much stress on that tendon during normal activity if it is still physically injured to make any progress.

I would definitely be looking to get an MRI if there's no healing. There could be other issues at hand, and the tendon is just another symptom.

thanks everyone for the diversity of ideas.

much to think about.

I'm late, but I'll agree with the folks that try not to rely on foot doctors. They know what they are told and what they observe… just like the rest of us. We hope that they know more than some guy with the internet, but most foot/shoe studies have been done by Nike, in the name of making profit rather than keeping feet healthy. This is changing with the barefoot hubub, some more studies are being done to see if there is validity to the barefoot movement.

From what you've said, it sounds like not being used to the lower drop shoes and overdoing it.

I'd second that you need to rest it… but after a year, I'd go to the podiatrist… I just wouldn't take anything they said as gospel.. I can already tell you what 90% of podiatrists would say, "get more supportive and cushioned shoes, then have insurance buy some $400 orthotics (do they still cost that much? also, orthotics are kinda the opposite of low heel drop shoes…), then rest for a month and see what happens."

Good luck.

I'm so thankful that I've apparently lucked out with such good podiatrists LOL

art~
curious to hear how things are shaping up with your a.t.?

I'm late on this thread as well but a friend of mine who is an avid work-out person and runner had a.t. problems. She finally went to an orthopedic surgeon who did an MRI and discovered a bone spur on her heel that was tearing the a.t. and ended up having surgery to repair it. She is doing well and has turned to swimming during her healing process. She finds that she won't be able to be as intense in her land workouts as before, but that's ok. She has her swimming and now walking until it totally heals.