help, sore achilles

A snowHead

damaged both left and right doing squats incorrectly with weights about 4 months ago. did nothing about it till about 6 weeks ago when i started physio. this wasnt having much impact so my physio recommended cortosone and fluid injections which i had done in the hospital last week. had my first run out test this evening and am now here on the sofa with ice packs on my sore heels almost back to square 1. supposed to be doing ski trip to tignes 1st dec!! getting really worried now along with being seriously pissed off. any one out there overcome this problem? yes I know you are not qualified to diagnose with just the info I have given but any help/advice would be very welcome.

A snowHead

I had Achilles Tendonitis a few years back, my physo prescribed sets of stretching and strengthening exercises which were very effective. They mainly involved heel drops but the main focus was literally hundreds of reps per day, its a pita but works.

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jbob, ya had been doing those but only 2x 10 reps times a day, so prob need to increase substantaly by what your saying
how long a recovery time did you have and did you do any exercise at all legs wise during that time?

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Sore? I'd say sometimes slightly cantankerous but not sore. Wait, not Achilles? Ohhh...

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You did not mention stiff calve muscles, but I would guess if the physio start looking at triggerpoints and spasm there it might go a long way to taking some tension from the achilles. Also stretching of both muscles will help. ( One with bent knee and one with straight knee )
Second heellifters, as from SZK, and really be very carefull with cortisone as it makes the achilles very brittle for a while, a lot of total ruptures happen that way...

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Go and see a sports therapist instead of a physio.

After all it is free

creedgearoid,

First of all I am not a medic however I have had achilles problems in the past.

The first question is how old are you? A physio I was talking to socially, rather than in a a professional capacity, once told me that the achilles gets brittle as you get older and once you get past fifty (I think he said fifty) there is virtually no elasticity at all therefore you have to be very careful when stretching.

It's always very tempting when stretching anyway, to overdo it, but with your achilles you are in danger of making it worse. Think more about exercises that stretch your calf muscles specifically, which will take the strain of your achilles. You should not have to do massive numbers of reps. I would suggest a small number of stretches maybe three times a day. Achilles injuries do take a long time to get over unfortunately and I doubt if there is any short cut.

I do recall the first time I had a bad achilles problem which was way back in my rugby playing days. I had a skiing trip coming up in the not too distant future so I was worried. Although my achilles was not fully recovered by the time of the holiday, I was fine for skiing as I found that the ski boot prevented any excessive movement. Of course you said that you have injured both. I would suggest without leaving it to the last minute, that you have a try out on an artificial slope and then make a decision.

A sports physio is obviously a good idea unfortunately the various excellent physios I have visited over the years were not skiers themselves, which would have helped.

I hope this may be of some help, but I repeat I am very much a layman in medical matters.

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richjp, yeah i am at the wrong side of 40 so could be a lot of truth in what you say as I have never in my life had any achilles injury before.interesting to read you recommend against too much stretching opposite to jbob. sarah, 2 YEARS!! im going insane after just a few months. what do you do to get some exercise or do do you stay off your feet most of the time? had a 3 week break of 0 lower body exercise except for a limited amount of walking and was almost pain free. but after my first run the soreness returned again straight away. lizski,.and evryone else who mention, have 2 pairs of orthotics already which i have been using for years with 0 problems + ski footbeds so well covered in that area but what do ye mean by heel lifters? surely if my heels need lifting then this would already be in the orthotics, yes, no!!

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be interesting to hear what Freddie P had to say.

Not many orthopods seem keen on cortisone injections these days. TAs have a nasty habit of rupturing afterwards. My understanding of some of the theories on why it happens would support Richjp's desire to avoid repeated strain on it.

I'm a GP with an interest but no expertise in sports medicine - and have had minor achilles tendinitis in the past, but also blew out a big chunk of one calf skiing bumps 10 years ago.

Some personal views: I would not, repeat not run for a while. It is a high impact form of exercise which is tough on lower legs. I'd be swimming or cycling. I'd also be doing exercises 1-3 from this but you probably are already.

Unless you are a pretty bad skiier you should not be loading the back of your calf that much when you are skiing. When I blew my right calf I could not walk for 10 days but I could ski. But a separate problem might be how your ski boots felt against the tendons and their insertions themselves.

Anyway - usual caveats apply - seek proper face-to-face medical advice and don't trust anything you read on the internet. God knows who I really am Toofy Grin

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creedgearoid, heel lifters are an extra little wedge usually about 5mm that goes under your heel. What this does is to enable you to have a stacked position with less flex in your ankle. It will slightly alter the fit of your boot and it may be tighter over the top of your foot.

My personal history was finishing my 3rd season with a badly strained right tendon (I am over 40), this included a significant thickening and pain. I had also popped the right calf muscle a few years before. I had sports physo from the Warwickshire Cricket guy who sees lots of tendon injuries in pro bowlers.

The exercises were done over a whole summer and I was fully fit by the following winter so 6 months rather than 6 weeks.

The rational behind the high rep routine is that you both stretch and strengthen your calf muscle and stretch your tendon (which is increasingly difficult with age). However rather than the conventional blokes method ie few reps high load, which produces short large strong muscles, you adopt the birds routine, light loads, with high reps, which results in thinner longer muscles which increase flexibility. So at no point do you ever strain the tendon or muscle. One problem you will have is that working on only I was able to support the other in the early stages with the other leg. A luxury you won't have.

Other lifestyle factors which reduce ankle flex are lots of driving, and wearing high heel shoes. I do a LOT of cycling which helps a lot. I agree that skiing is easier than walking, but take care that your boots will support the ankle properly, ie stiff without too much travel.

stoatsbrother, had the injections done by a surgeon in the hospital who explained that because the procedeure was causing ruptures as you say, they have since changed the way its injected, ie before they pierced the ligament itself with the needle which resulted in rupture starting at that point afterwards but nowdays they dont pierce the tendon and inject around the outside of tendon instead. im not a big cortesone fan either but getting desperate

You know it makes sense.

creedgearoid, well good luck. Have you tried your boots yet?

Otherwise you'll just go on seeing the one name:

stoatsbrother, no not yet. only boots im worried about at the moment are my football (GAA) boots, supposed to be playing a leauge semi final next sun Sad

A snowHead

you have lots of different advice to consider.... I am a Physio working in the resort of Les Deux Alpes and for your reassurance have recently been treating somebody who ruptured his calf muscle from his achilles (a different but obviously serious injury!), didn't have surgery but 4 months later he is back to a very comfortable level of skiing...so don't give up!
My opinion is that as the initial injury was left untreated for several months, recovery is not quite as fast as you may have hoped. Applying ice when you feel sore or after activity is very helpful. A very gradually progressed strengthening & stretching programme for your achilles & calf muscles is essential, including eccentric exercises (strengthening the muscle as it is lengthening rather than shortening) - ideally with supervision and guidance from a physiotherapist (if you're not happy with who you were attending, seek another, especially one experienced in sports injuries). Various soft tissue techniques/joint mobilisations may also be used by your Physio to help your recovery. A biomechanical assessment, as mentioned by others, is very worthwhile to assess your legs/feet and how your weight is distributed - to see if orthotics/footbeds would be appropriate to help your alignment. Before pushing yourself to get back to running start with things like cycling, swimming and even walking/jogging in the pool; don't push to the point of pain; walking on an air cushion or using a wobble-board will help gently stress the achilles but shouldn't be painful, will also help your balance & prepare you for the skiing terrain. Obviously I would need to have assessed you to be able to be more specific but I hope this advice helps a little. Finally, it is not unusual for achilles problems like yours to take some time to recover fully so do persevere with it- do little often - and I'm sure you'll start to see positive changes.

A snowHead

physio2alpes, thanks for all the info and encouragement

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creedgearoid, 2 years on and off, had one physio who wasn't very good but then I changed to my current one who is very good. Having said that it then took about 5 months for my left to completely settle down and then not long after that my right started and has been going on longer Sad

It's not so bad that it really stops me doing anything although I don't really run on it. Walking and cycling are fine. It is just very annoying, very stiff and painful first thing in the morning to the extent that I can't get full range of motion to walk properly. It improves after 40 mins or so. If I stop wearing my orthotics it worsens very quickly. The only time I get almost total relief from it is during and just after a skiing holiday, the position of my foot in the boot, totally supported is exactly what it needs. I think this is why this night splint seems to be helping, it is very similar to wearing a ski boot. I need to ski more, that's the cure Toofy Grin

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Agree with Sarah. I have suffered with Achilles problems for years (overpronator when walking/running) and had to have orthotics in my shoes. Cost £150 but worth every single penny!

The Achilles have improved remarkably. Shame I am crap at skiing!
Dobster

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help, sore achilles

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