The tortoise wins this one

September 19, 2012 7:36 AM

Is there any overcoming Achilles tendonitis?

Hey all,

Well, it appears that my long battle with chronic back pain left me with Achilles tendonitis. Apparently, all the standing I was doing when it was too painful to sit literally inflamed my tendon. Furthermore, I started feeling pain when walking and standing, but didn't take it seriously until it got to be quite severe.

When it began hurting at the end of July and I got my diagnosis, I spent about a week lying down, taped up my ankle, got a cane, did some gentle stretching, and slooooooowly returned to normal levels of activity as the pain eased up. (And by normal levels of activity, I mean walking and standing... I am not a runner.) Unfortunately, last weekend, I walked up a hill for the first time in 6 weeks (I teach on a campus that is basically built on them ... avoiding them is challenging) and it has returned with a vengeance. It is extremely red, swollen and, despite the ice, ankle boot, orthotic inserts, etc., nothing seems to be improving. It is in pain when I am at rest too, although obviously not as much as when I move around. I also have a stomach ulcer, so I have not been taking any anti-inflammatories even though doctors are saying I may be able to in small doses.

A visit back to the doc and perhaps back to my physical therapist is obviously next on my list, but I no longer have the luxury of lying down literally all the time. I have a class to teach and my own work to get through! I have spent last semester recovering from back pain physically and mentally and was just starting to get excited at the thought of having a normal, mobile life. Has anyone experienced tendonitis that is this debilitating? Should I be completely bedridden while I wait for the swelling to go down? Not walking at all is extremely impractical, yet it seems to be the only thing that helps. :(

Thanks, y'all, as always.

posted by bookgirl18 to health & fitness (14 answers total)

You don't have to be bedridden, but see if you can sit during your classes with your ankle elevated. Keeping it elevated is super important! Also, try wrapping a tensor bandage around it. If you're not willing to take NSAIDS, there's not much else you can do on your own.
posted by windykites at 7:48 AM on September 19, 2012

Try visiting a DO instead of an MD about this problem.
posted by bilabial at 7:53 AM on September 19, 2012

There is surgery to fix this. It's pretty reliable, but a last resort.
posted by crawltopslow at 8:04 AM on September 19, 2012

In college, at age 18 or 19, I injured my tendons in my dominant hand and arm and reaching into my back. In really cold weather in my twenties, it left me unable to get out of bed without assistance and seriously limited use of my dominant hand. Two years of consuming gelatin (emptied a packet into a cup of hot water, added juice, drank it) every day went a long way towards resolving the issue. These days, I rarely have trouble.

You can memail me if you care to hear more unconventional thoughts on what might also help.
posted by Michele in California at 8:06 AM on September 19, 2012

I'm not sure about the immediate short-term without NSAIDs, but in the medium and longer term, physical therapy should help this. Mobility WOD has started a series on feet (and the related systems) that are very good imo (part 1, part 2).

I've suffered from Achilles tendonitis (running too much) and so does my daughter (injury plus weak hip muscles). Fundamentally, it starts with tight calf muscles and range of motion there, so exercises to stretch those muscles and increase range of motion are the first place to start, e.g. towel over toes pulling towards self for 15 seconds three times; 30 seconds standing stretch with one leg behind heel on floor - 3 times; foam rolling the calf; developing strength by writing the alphabet with your ankles; this exercise I do against a post or door jamb.

With that said, it's a system. If your hip muscles are weak, then you'll turn out your ankles to compensate and create stress on the Achilles, so you need to increase strength in your hips (standard leg raises help with those; standing on one leg while brushing your teeth or hair or doing dishes; learning to squat with proper technique).

It will take a long time to heal and stop hurting. It just does. You have to be patient and not aggravate it.
posted by idb at 8:39 AM on September 19, 2012

Obvious stuff, but for ice, a bag of sweetcorn or peas works well and conforms to your ankle well, 10 minutes twice a day. Don't overdo it and don't overuse the boot, and make sure you have good shoes - a running store is a good place to get a proper evaluation. Don't wear flip-flops. Compression and elevation.
posted by idb at 8:52 AM on September 19, 2012

Great advice from idb; however, you should NOT be doing these stretches until this inflammation (swelling) subsides. Seriously. No stretching an acutely inflamed area!
posted by windykites at 9:16 AM on September 19, 2012

I also have a stomach ulcer, so I have not been taking any anti-inflammatories even though doctors are saying I may be able to in small doses.

Wait, why isn't your stomach ulcer resolved? Nobody should have chronic stomach ulcer these days. Was your ulcer definitively determined to be non-bacterial? Have you been on Nexium or similar? Please get a second opinion from another gastroenterologist.

On to your Achilles tendon. First of all, you need topical NSAIDs, like Voltaren (prescription-only). And I know that not every doctor agrees that this is effective, but during the time I was forbidden to take NSAIDs orally, my rheumatologist suggested a double dose of this and I found it helped to an extent, although not as much as the magic NSAIDs.

And talk with your campus disabilities coordinator. You may be able to get rides from campus police or facilities maintenance while your tendonitis is healing.
posted by Sidhedevil at 11:11 AM on September 19, 2012

Oh, yes, my doctor suggested topical capzasin if Voltaren was too expensive or not covered.
posted by idb at 1:01 PM on September 19, 2012

Thanks all. Clarification - i had some stomach bleeding caused by ibuprofen about six months ago, and everything seems to have resolved. Docs seem to disagree as to whether I can try some NSAIDs again and how to do it.
This kind of swelling and pain is just worrisome - I guess I didn't realize tendinitis could be utter constant agony, not just post-workout or while moving.
posted by bookgirl18 at 2:26 PM on September 19, 2012

Mine have been hurting for the last three years, to the point where I don't even walk much any more. Running and jumping are totally out of the question.

First thing I found that actually helped was leg massage from a competent myotherapist. And she advised me to stop going barefoot, ever (which I used to do all the time) and get some night splints.

I didn't get the night splints but I did commit to putting my boots on every. single. day and got a pair of these Airheels. My injuries are way down low in the tendons, right where they attach to the back of the heel bones, and my feet are not even slightly flat, so the tendon-massage effect of the Airheels is minimal to non-existent; also, over time they seem to have lost air. But the effect of the non-elastic ankle strap that forms part of them is to pull the tendon in closer to the bone, which seems to reduce its tendency to try to tear itself back off. Wearing the Airheels inside my boots, I don't usually need painkillers.

Gentle eccentric calf stretches have been good.

The thing that's been helping the most, which has pretty much completely got rid of the leg oedema and seems to be slowly reducing the mis-shapen lumpiness of the tendons behind my heels, is resuming a long-neglected habit of regular bicycle riding.
posted by flabdablet at 9:59 AM on September 20, 2012

When I had a pretty bad inflammation a couple years ago, one of the main stretches I was told to do was to (while seated) cross my legs down by my ankles, with my legs up. I put a ball (like a cheap child's inflatable ball with about a fourth of the air let out), between my feet. With my legs crossed, I was holding the ball with the outsides of my feet. The PT told me to squeeze the ball between my feet, then release, just as something to do whenever I was sitting. It definitely helped.
posted by Ghidorah at 5:33 AM on September 23, 2012

In case anyone looks at this thread again - I finally got myself an MRI and it turns out I do not have tendonitis, but an actual partial tear of the Achilles. :( The moral of the story is - get an actual MRI to confirm these things!
Thanks again, y'all.
posted by bookgirl18 at 6:27 PM on October 14, 2012

If I understand my own tendinitis correctly it amounts to a whole mess of micro-tears (some of which have now calcified) and that as far as healing goes, there won't be much difference between the post-repair state of your partially torn one and anybody else's inflamed one.

The main thing I think you will need to keep in mind is that these bastard things heal incredibly slowly because they don't normally have a blood supply; tendon cells rely on nutrient diffusion to keep them alive and functioning. They grow a temporary blood supply (this is "vascularization") while they heal and they also grow nerve connections to some extent, which is part of why they hurt so much. That pain needs to be taken seriously! If you're using a healing tendon in ways that hurt more than a dull ache, you're setting its healing back and this is pretty much how tendinitis happens.

You're going to need to treat your damaged Achilles as gently as you possibly can for many more months than you think you need to, because even after it stops hurting it will be nowhere near full strength. Give it as much support as possible and take as much load off it as possible without totally immobilizing it. Above all, listen to your surgeon's advice and take it seriously.

It's going to be frustrating as hell, but I can assure you from the perspective of somebody who Did It Wrong that the pain and frustration involved in that path is worse.
posted by flabdablet at 8:31 PM on October 14, 2012