Member Case Study: Chronic Achilles Tendon Pain

author : AMSSM
comments : 0

I am 52 year old female with chronic (over two months) pain over left achilles tendon that worsens with running. On exam, my left achilles is tender to direct palpation.

Member Question from charlotte hobbs

"I am 52 year old female with chronic (over two months) pain over my left achilles tendon.  I train for a half marathon and one or two sprint triathlons per year.  My BMI is about 24.  I am a slow runner - about 10 to 11 minutes per mile.  While running over past two to three years, I use Jeff Galloway's methods of mixing running and walking.  An intense week for me would be 8 to 10 miles.  I purchases new shoes every 8 to 12 months from a specialty running store after they have assessed my gait.

I experience daily pain over my left achilles tendon that worsens with running.  I have tried the following:

-  Rest X 2weeks + scheduled naproxen + ice  + stretching + compression tape when returning to running.

- I have tried the above 2 times now with some relief of pain that returns when I return to running

On exam, my left achilles is tender to direct palpation.  There is some mild edema and a possible nodule.  Do you have any suggestions for complete recovery?"


Answer

It sounds like you have had a frustrating couple of months. Achilles tendon pain is a difficult problem to resolve. Early on, Achilles tendon pain most often is tendonitis characterized by inflammation within the tissue. If the condition continues, tendonosis often develops. Tendonosis lacks the inflammatory cells of tendonitis. A disorganized irregular tissue becomes more prominent and may cause pain for multiple months which can persist through early treatment. Your current situation is concerning for the development of tendonosis, which I find more difficult to treat than tendonitis. With that in mind, I believe you will need to invest some time into treatment now before it worsens. Ideally, you are at a break before your next competition.

Initially I will have patients try a treatment plan on their own. This usually consists of a period of relative rest, meaning restriction to only regular everyday activities. During this period of rest, I encourage similar ideas to what you have tried. I recommend a brief period of non-steroidal anti-inflammatories (NSAIDs) such as naproxen. The idea of the NSAID is to allow patients to do the stretching needed in rehabilitation. I try to keep this less than 7-10 days because of a rising concern that NSAIDs may precipitate the formation of tendonosis. If the patient is able to do the stretches and the pain is tolerable, I often don’t recommend NSAIDs at all. Next is stretching, which needs to be done on a regular basis. It should include stretches for both gastrocnemius and soleus muscles within the calf. Again like you have done, I recommend ice after being on your feet for work or after the stretches. On occasion, heel lifts can be used early on to take tension off the Achilles but stretching must be done during that time. The period of relative rest lasts as long as needed to become pain free on a daily basis.

Once pain free, start a slow progression back to activities. I emphasize slow, because a quick return to previous activity levels often reaggravates the initial injury. First, start with walking only for shorter periods of time. Once you are able to do that without pain, advance to biking if you have it available. Next is an elliptical training machine followed by interval jogging and walking. Start with short periods of jogging gradually increasing time until you are back to pre-injury levels. I would anticipate that each step would take approximately one week. That is just a guide, so if you feel great with one step for a couple days, go ahead and advance early. If you develop pain with one step, fall back to previous step and consider trying again after another week. Ideally this slow progression back will prevent any major setbacks in your recovery.

Unfortunately, this does not work for everyone. A more significant injury such as tendonosis may be present. So if you are unable to advance after a 2-4 week period or your progress is unacceptably slow, consider seeing a local sports medicine physician. Other treatment plans, such as a formal physical therapy program, may be more appropriate following a personal evaluation and exam.

Rating

Click on star to vote
9827 Total Views  |  73 Views last 30 days  |  19 Views last 7 days
date: November 23, 2009

AMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

avatarAMSSM

The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

View all 360 articles