Insertional Achilles Tendinopathy -- HELP!

Hey all,

So I've got major pain (when stretching with dorsiflexion) at back of my heel. Very sharp pain. So I'm icing it and wearing a brace (to avoid dorsiflexion). I'm going to start rehabing it when the pain/inflammation diminishes. It's all very discouraging. Has anyone else dealt with this? If so...

1) What worked best for rehab? What to avoid?

2) How long did rehab take?

3) How do you know when you're ready to attempt any kind of dorsiflexion again? I'm terrified to bend my foot b/c the pain is so sharp.

4) How do you know when you're able to climb again?

Thanks for whatever you've got!

Bumping this up. Help!

Thanks, Cris! Much appreciated.

How do you know when you've recovered enough to 'test' dorsiflexion? Is it through gradual increases in calf raises? 

Symptoms started nine months ago. Started climbing a month ago but taking it easy.

Massages, PT (for 5 months),  Iontophoresis with dexamethasone (twice a week for 6 weeks), Voltaren to reduce tenderness and swelling (on and off). Alieve for 3 weeks.

Sleep in a boot. That was definitely one thing that made a big difference!

You can do bike, swim, anything that does not cause pain.  Same goes for any calf exercises, nerve flossing, etc. stop if you feel pain.

Could take up to 18 months to fully recover. 

Don't start running too soon. Climbing seems ok, some movement feels like PT.

I had similar symptoms, and my Achilles eventually ruptured despite trying a lot of conservative treatment. Turns out it was due to Haglund’s deformity (bony overgrowth on the heel, where the Achilles attaches to the bone), as opposed to an isolated tendon issue. 

The initial trigger for me was running, and possibly constant pressure on the heel bone from climbing shoes. If the symptoms are persistent, you may consider seeing a sports medicine doc to get it evaluated since treatment may differ depending on the underlying cause of pain.

https://medschool.cuanschutz.edu/docs/librariesprovider65/courtney-grimsrud/patient-handouts/haglund's-deformity.pdf

Hi Eric!

I'm a PT and have seen a fair amount of tendinopathy, it can be fairly stubborn but PT is the best line of defense for this condition. It sounds like with the intensity of what you're feeling you would benefit from being treated by a physical therapist in your area so they can assess your unique needs. Overall the secret to success is loading the tendon in a calculated way! The time estimate I typically give for tendinopathy is 12 weeks minimum. It varies from person to person because in those 12 weeks, you need to be able to load the tendon and be consistent which can be difficult while balancing discomfort and the rest of your life so it is not uncommon for full resolution to take longer. I'm going to include an article from The Climbing Doctor blog about Achilles tendonitis, the treatment looks fairly similar to tendinopathy. I would only add that you should really prioritize recovery, nutrition, and sleep over the next few weeks and incorporate moderate-intensity cardio as much as you can to get your muscles pumping fresh blood full of nutrients to the area. I'm also going to include the exercise guidelines for what is "good" and "too much" for soft tissue injuries. 

https://theclimbingdoctor.com/achilles-tendonitis-rock-climbing/

EXERCISE GUIDELINES

• RED is 5+/10 pain = STOP

• YELLOW is 3-4 = monitor 24 hour response to see if loading was appropriate or too much

• GREEN = 0-2 SEND IT

Let me know if you have any questions!

Thank you all for your thoughts! Much appreciated.

I have started a rehab program with a PT, so I'm on the path to recovery (I hope!). And he said along the lines of what you all have said. It's all about strengthening the tendon, progressively loading it. I climbed last night wearing a boot, and it was fine. So I'm just buckling down for a few months of rehab, and hopefully I'll be bootless soon!

Thanks again!

Hi Eric, I had the same issue about 18 years ago.  I tried the boot and rehab over the course of 6 months, but never it never fully resolved until I identified the true source of the inflammation.  In my case, the inflammation was caused by undiagnosed Psoriatic Arthritis.  Once I figured it out with the help of WebMd, (several orthos, MDs, and a podiatrist missed the correct DX), I went to a rheumatologist, got biologics treatment for my PA which curbed the inflammation, and was back to 100% within about 3 months.  

So, if after your rest/boot/rehab, you are still having issues, try looking into what may be a systemic cause of inflammation.  

bob steed wrote:

Hi Eric, I had the same issue about 18 years ago.  I tried the boot and rehab over the course of 6 months, but never it never fully resolved until I identified the true source of the inflammation.  In my case, the inflammation was caused by undiagnosed Psoriatic Arthritis.  Once I figured it out with the help of WebMd, (several orthos, MDs, and a podiatrist missed the correct DX), I went to a rheumatologist, got biologics treatment for my PA which curbed the inflammation, and was back to 100% within about 3 months.  

So, if after your rest/boot/rehab, you are still having issues, try looking into what may be a systemic cause of inflammation.  

Thank you for sharing your experience with Psoriatic Arthritis. I might have it,  rheumatologist did not see the need for biologics treatment at this time.