Learn me: Achilles Tendonitis

Or rather, how the berkeley do I get this to heal properly?

Backstory - I injured my achilles tendon sometime back in April or early May, can't quite remember. It wasn't torn, at least not to the extent that it would've moved my inswearants company to pay for an MRI. After an initial diagnosis of "it's probably stretched a bit, here are some crutches and opoids, just hobble about at bit and it'll be as good as new", I finally got an appoitment with a podiatrist about a month in. He didn't quite agree with the first doctor's approach (he didn't *say* anything, but I should've recorded his facial expressions) and put me into a removable Aircast with strict instructions on what I couldn't do, plus some meds to knock down the inflamation.

His diagnosis was "it'll take anything between a few weeks and a few months to heal".

I ended up wearing that Aircast for over two months, until early August IIRC. Since then, I *should* be OK just wearing supportive shoes with silicone heel cups. Only that "OK" is a rather vague description. Yes, I can walk, but not as much as I want and need to. I also can't drive a manual for any length of time - I made the mistake of taking the Mini Cooper to the Bay Area for work once, and pretty much spent the following weekend on the sofa with my foot in the air, swearing and popping the occasional pain killer. Given that I pretty much never willingly take painkillers, you can guess how bad that was. At the moment, I either have to grab a bike or the e34 as the effort of working a clutch seems to massively aggravate the remaining injury.

It's also knocked any sorts of motorsports activity on the head, at least for this year. There's currently no point in even trying to get the Formula car going (yeah, motor is still in bits) and I just had to skip Miatas at MRLS, which I'd been looking forward to for months. I couldn't drive down there, let alone walk around the paddock.

So, back to the original question - any proven strategies to help with speeding up the healing process? I'm planning to get a third opinion from another podiatrist in the next few weeks, but appointments with specialists do tend to have a fair amount of lead time out here.

I empathize with you. My Achilles is my Achilles. I've had this condition several times during the past ten years or so (both sides). Each time it was brought on by my walking exercise program. It wasn't the walking per se, but rather walking with the wrong shoes, and/or not stretching my calf muscles and Achilles' tendons sufficiently prior to going out. I was about 15-20 pounds over my ideal weight each time, so that might be another factor, because I never had the problem when I was younger and weighed less. Went to an ortho doc the first time, but that really didn't help. Each episode took 4-6 months to heal. I really don't think there's a quick fix once you've injured your Achilles. For me, preventing it from happening again is important. Stretching (check YouTube), proper shoes, and attempting to reduce my weight. 

My achilles story starts with a rolled ankle at basketball that I kept walking on but changed my stride. After retraining my body how to walk improperly, my achilles started getting inflamed - literally hot to the touch. Podiatrist sent me to PT for therapy to retrain my stride. PT lady looked at my feet and diagnosed me as equinous. Essentially my foot is built wrong. Picture a foot inside a cowboy boot, how it has that raised heel and a slight lean forward. Apparently my foot does that without the cowboy boot. This means that lowering the heel that half inch to the ground, overstretches my calves and achilles. Prior to the injury, my calves were very prone to cramping. Now, with boots or basketball shoes with large heel lifts, I'm generally fine.

I had killer tendonitis in my right achilles two summers ago, that I just could not get to heal up.  Very long story short, the root cause were two herniated discs in my lower back, which were pinching the appropriate nerves that caused the muscles in my right calf not to be able to relax.  Fortunately, once properly diagnosed via an MRI, I received an epidural steroid injection at the herniations, which allowed the swelling in the herniated disk region to go down, and all got better.  Now days, when either achilles feels tight, I take it real easy on doing anything that might cause stress in the lower back, and all heals up.

So, you never know what might fix the symptom.  I sure wouldn’t have guessed what was the root cause on my (apparent) tendonitis!

I am sorry to hear its taking so long to heal. I rolled my ankle likeJohnboyjb. Similar to you I wore an aircast for a couple of months. It wasn't bad enough to keep me from driving a stick, but then again wasn't doing the drive to your part of the world either.  I know what it is like when you hurting and seems like it taking forever to heal.

Regarding Miatas at MRLS, you might ask Rick and company if you can borrow or rent a golf cart to get around.  You would 't have your ND to show off, but you could still be part of the event.

I hurt my Achilles tendon in 1987.  Half-cast, shots, etc.  Almost healed now!

Ok, it does remind me of its presence after climbing lots of stairs, standing too long on slopes, or after long, fast walks.  Ibuprofen helps in those situations.  

Just my little ray of sunshine.  You're welcome.

Well, that was an encouraging batch of posts then .

In a sense I'm glad that it seems to be normal that it takes this long to heal, but I"ll still try to get another opinion as the inability to drive cars with a clutch for any meaningful amount of time is beginning to seriously annoy me.

Is it painful where it attaches to the heel in the back, is it tender or swollen farther up the tendon?  The blood supply to the Achilles is poorest a few inches above the insertion at the heel, which is why it tends to rupture there.  Is it sore at the bottom of your foot anywhere?  

Ice applied directly to the painful area for 10-15 minutes at a time will help.   

I also like the use of contrast baths.  Apply ice 3-4 minutes, warm, like a heating pad on low warm, for a minute, then back to ice for 3-4 minutes.  Start and finish with cold, alternate until you have done it about 20 minutes.  A heel lift will help, put one in both shoes so you don't create an iatrogenic limb length discrepancy.  Idea is that the lift lets the Achilles rest a bit.  Anti-inflammatory like mo trin will probably work better than narcotics.

You may find that if you move the seat forward, it will bother you less to work the clutch.  Move your foot up the pedal so it is hitting more in the arch than the ball of the foot.  This will reduce the strain on your Achilles.  I have seen Achilles injuries take a year to get to 75-80% and have that be as good as it gets.

kinesio tape also seemed to really help me. Who cares if it is psychosomatic response?

It is not a psychosomatic response.

Toebra said:

Is it painful where it attaches to the heel in the back, is it tender or swollen farther up the tendon?  The blood supply to the Achilles is poorest a few inches above the insertion at the heel, which is why it tends to rupture there.  Is it sore at the bottom of your foot anywhere?  

It's right where the tendon attached to the heel, and sometimes the bottom of the heel gets sore as well.

A combination of the right shoes, ice and if necessary a contrast bath seem to help.

You may find that if you move the seat forward, it will bother you less to work the clutch.  Move your foot up the pedal so it is hitting more in the arch than the ball of the foot.  This will reduce the strain on your Achilles.  I have seen Achilles injuries take a year to get to 75-80% and have that be as good as it gets.

That does appear to help a lot, thanks for that recommendation. I was able to drive the MINI for half an hour each for a couple of days last without the foot getting excessively painful, but I'm still wary of venturing further.

Type Q said:

I am sorry to hear its taking so long to heal. I rolled my ankle likeJohnboyjb. Similar to you I wore an aircast for a couple of months. It wasn't bad enough to keep me from driving a stick, but then again wasn't doing the drive to your part of the world either.

Funnily enough the bigger problem is driving in your part of the world, especially when I have the joy of driving from San Jose up to Millbrea and back...

Zombie thread, canoe deleted

Bah, and here was me hoping for new insights. It's definitely time for a second opinion, just need to somehow manage to fit said opinion into my work schedule.