This past year, I struggled with Achilles tendonitis (tendonosis) in my left foot. It started out slowly during the summer, and as my mileage increased, so did its severity. I’ve mentioned my experience a few times in my podcast, but I thought I would give a summary, as well as an update of where I stand at the moment.
If you’re struggling with Achilles tendonitis, the posts in this 2-part series may help convince you to see a sports medicine doctor or physical therapist, which, ultimately, will save you from more chronic conditions or permanent damage. The good news is that Achilles Tendonitis is easily treatable, especially if dealt with at early onset.
Note: Before continuing, please understand that what I describe below should not be interpreted as medical advice or treatment. This is just a summary of what I was told to do by my doctor and physical therapist.
During my training runs, my Achilles felt fine. But during my off hours, as I progressed through my training program, I was experiencing more and more pain. This pain was more noticeable during the morning hours, as the muscles were stiff after a night of sleep. I also experienced a little pain during the first few minutes of running, until I was warmed up, after which it went away. For me, I actually felt better when I ran.
When I did experience pain, it was at a very small but focused spot on the back side and middle of my heel, about one inch up from the bottom of the foot.
Occasionally, I had what I can best describe as a burning sensation around the sides of that spot.
Prior to seeing a sports medicine doctor, I self treated with all but the compression principle of RICE (Rest, Ice, Compression, and Elevation) treatment. I also cut back my weekly miles to an absolute minimum and changed my race goal from going after my marathon training full bore to just getting by with race completion. I knew I would have a couple of off-training months before training kicked back up in January for a Spring half-marathon, and I would address my tendonitis then.
After the race, I stopped running completely. However, even after a couple of weeks there was no improvement in my tendonitis. I might even argue that it got worse, probably due to lack of running, which I believe caused further tightening of the muscles in and around my calves and feet.
So in early December, I finally saw a sports medicine doctor and was referred to a physical therapist for treatment.
The first thing the physical therapist did was evaluate my flexibility and pain points in my feet and legs. He also analyzed my walking and indicated that he saw my heel lifting up too early as I walked, which was causing a strain on the back of my foot. He said my calf muscle was too tight and was causing the back of the foot to pull up too soon.
So he prescribed a series of treatments (for pain, swelling, and inflammation), as well as a series of exercises and stretches to help stretch the calf muscles and build up some additional strength. The idea of loosening the calf muscles was to prevent the heel from pulling up too soon, thus reducing that pressure on my Achilles.
To help reduce the inflammation and calm the area, an ultrasound therapy was applied for about 5-10 minutes each session. Ultrasound therapy is used to increase blood flow around the area to help reduce swelling and speed healing. The vibrating sound waves can travel deep into the tissue, creating gentle heat. The heat increases the blood flow to the area, which in turn delivers oxygen and nutrients and removes cell wastes. The deep heat also helps relieve pain, inflammation, and muscle spasms. Not only is the treatment completely painless, it’s quite enjoyable and you feel great for a few hours after the procedure.
The following 17 second video clip gives you a basic idea of what this procedure looks like:
In addition to the non-diagnostic ultrasound, I also received electrical stimulation therapy.
Electrical stimulation therapy is painless, but just like ultrasound therapy, it takes several treatment sessions. Since it is painless, I barely even noticed it all. Occasionally I would feel a slight itch, if anything, but nothing that ever felt like a shock. They attached pads to my Achilles that contained an anti-inflammatory steroid, and then attached another pad to the back of my calf muscle to apply the shock wave.
Shock wave or electrical stimulation therapy stimulates soft-tissue healing by increasing blood supply to the treated area. The degree of “shock” to the area is adjusted. The therapy can last as long as 20 minutes, although most of mine were around 10 minutes per session.
Electrical stimulation can also be used as part of iontophoresis, which I also had done. This treatment involves the application of a topical anti-inflammatory to the area. The stimulation forces the medication into the tissues reducing inflammation.
I was also told to ice the Achilles area a few times per day and continue that for as long as I can to help keep any inflammation down.
So far, I have talked about treatment options that help calm the Achilles pain and facilitate healing. In Part II, I show some of the stretches and exercises I did to help increase flexibility and strengthen the calf muscle to make sure this injury didn’t recur.
Photo courtesy of Chris Hunkeler