Achilles tendonitis

Discussion in 'Ask the Docs' started by Wideguy, Feb 25, 2014.

  1. Wideguy

    Wideguy Barefooters
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    Hello all,
    Back in June of 2013 I started to experience pain in my left Achilles about 2 miles into my run, fully barefoot. I immediately stopped and walked home. For months I didn't run, tried ice, tried rest, tried massage and nothing did it.
    In early January I saw my Rheumatologist for follow up on my Psoriatic Arthritis. He took x-rays on the achilles which showed nothing but he did feel a sizeable lump in the tendon and suggested PT. I did 2 months, the electro-stim felt great, the ice and massage felt great and I did regain a lot of strength and flexibility that I didn't realize i had lost in 6 months of favoring that leg. But it hasn't "cured" it. I still have pain and stiffness any time I sit for a while, mornings when I get up. I'm learning to mange it and continuing my stretches, squats and lunges but I want it gone.
    My Rheumy thinks it may just be related to the PsA and has recently changed my meds to hopefully drive it back. However my PT put me on this ALine platform and said I am very pronated on that left foot and she thinks that could be a contributing factor. So she suggested orthotics.
    Bottom line, I've never had gait issue or other issue before, and I had been working into BF running for 3 years prior to this with no problem other than being out of shape. I really am most comfortable barefoot or in very minimalist shoes and I'd love to be able to continue in those and get back to running. But if orthotics will help I'll give them a shot. I'd love to be pain free more than anything but I don't want to go back to being heavily shod the rest of my life.
    Could a pronation really be causing so much inflammation in that tendon and am I headed back to "Real Shoes" for good?

    Thanks in advance for any and all opinions. I figured some Barefoot friendly docs would be a good place to start.

    -Chad
     
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  2. Dr Emily Splichal

    Dr Emily Splichal Barefooters

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    Thank you for your question Chad.

    Based off of your description and the treatment you've done thus far for your Achilles tendon - my biggest concern would be to see the actual health of the tendon. I would want to know if there is any degeneration in the tendon - or possibly and partial tearing or fraying of the tendon fibers. Both of these can make it very difficult for you to resume pain-free activity (especially barefoot).

    To determine the health of the tendon you would want to get an MRI. This can easily be ordered by your Doctor and will be covered by your insurance.

    As far as pronation and Achilles pain. Pronation can be a compensation if you have limited ankle mobility - where limited ankle mobility can stress the Achilles tendon causing pan. AND pronation can stress the soleus fibers of the Achilles tendon - so pronation could be contributing to the pain.

    Does this mean you have to give up barefoot activity forever? Not necessarily. You must first determine the health and condition of the tendon. If there is degeneration then there are several treatment options to get your tendon young and healthy again - these include PRP, Topaz, Laser, Bone Marrow Aspirate.... After the tendon repairs itself you need to make the tendon elastic again which is done through eccentric training and myofascial work.

    Achilles tendonitis can take months to recover from and requires daily myofascial release and work to keep excess stress off of the tendon. You may need to resume to traditional footwear / sneakers for the time being and then transition back to barefoot.

    I hope this helps!
     
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  3. Wideguy

    Wideguy Barefooters
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    Thank you so much for the response Dr. Splichal. I have n Appt. with my rheumatologist in a week. I'll push for an MRI then. If he won't order it I'll talk to my PCP.
    Is the release therapy something I will be able to do at home or with that be something I would have to continue PT for?
    I really appreciate the time. I have a lot more information to ask smart questions of my doctors at least.
    Thanks again.
    -Chad "Wideguy"
     
  4. Backfixer

    Backfixer Barefooters

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    Usually when there is a a callous formation at the back of the foot as you described, that is due to over and understriding, which will cause you to impact the ground hard. This is the most common reason for problems in the achillies, not one of weakness. What I would also expect with your overpronation diagnosis is asymmetry which is inherited. The idea that you never had the problem before begs the question, did you have other problems in the back or neck or shoulder which is usually a reflection of gait, leading back to the foot.

    Regarding the fear of foot orthotics, depending on the gait style you have, an orthotic does not have to be huge and bulky. I am familiar with A line and purchased a pair for myself 6 months back. I just removed them and put in powersteps off the shelf inserts because the posting on the aline came off and I was having shoulder and core issues more pronounced than usual (I am a chiropractor, after all; white collar worker doing physical labor :) ) Bottom line, you may be able to get an insert that is off the shelf that is relatively low cost and relatively unobtrusive and put them in a minimalist style shoe which may help quite a bit.

    I do not believe the doctor you saw gave you a bad diagnosis, the problem always is does the recommendation solve the problem. I do not believe there is a one size fits all solution for everyone, and some people excel barefoot, some have problems both shod and barefoot and some have great mechanics that work either way. Nobody has determined which type of body style works best with which style of running yet, but hopefully some day, we will understand that better.

    Good luck.
     
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  5. Wideguy

    Wideguy Barefooters
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    Thanks for the response. I'll get the MRI as previously mentioned, then maybe see someone in your profession as well, see if I'm all lined up. ;)
     
  6. Wideguy

    Wideguy Barefooters
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    GRRR Very frustrated... saw the orthopedist two weeks ago. He pushed me off on the MRI, saying he was sure it wasn't a full rupture and it was either small tears or just bad inflammation, but in either case the treatment would not change. I'm sure they are trying to keep unnecesary testing down and he may be correct on the treatment but he suggested I try heel lifts and a night splint and my pain has gotten worse. Should I keep pushing for the MRI?
    Just very frustrating. I've scheduled a follow up on the 30th, the soonest I could get in. Should I keep pushing for the MRI? Is there any other questions I should be asking?
     

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