Return of the a Achilles tendinitis

I'm a PT and willing to chime in to back up what others have said. Not only have I treated patients with achilles tendinopathy, but I've successfully recovered from that as well. A good PT will be skilled enough to determine any mechanical limitations of the ankle/foot or poor movement patterns throughout your kinetic chain. This often requires manual treatment and exercise for the hip, knee, etc. So, its not always as simple as doing some exercises for your achilles. HOWEVER, we have pretty well-established clinical practice guidelines that recommend exercise as the main treatment because the problem in the end is the tendon is in poor health (assuming there are no tears as mentioned before) and the only way to really get it back to normal is to appropriately stress it through exercise so that it remodels back stronger and stronger over time. Exercise can be effective in different forms (i.e. eccentric, heavy-load, slow speed, progressive, isometric, etc.). In my experience, heaviest loads that are tolerable done in a slower manner (3-4 seconds up, 3-4 seconds down) are a great starting place. If that is too much for you to start, then long-held isometrics are good. Guidelines indicate that frequency of training may not matter too much, but don't overdo it early on. Progress the loads (resistance, # of reps, # of sets) as your achilles can tolerate. Eventually you want progress to where you do more dynamic exercises, meaning speed of movement, but you'll need to drop resistance back down and then slowly progress that back up as your tendon tolerates it. Good luck to anyone dealing with this. I feel for you because it really sucks and can be a bitch to deal with. However, there is a way back to normal function. If you can get to a good PT, do it.
 
Have any of you had “exploratory” tendon surgery? How is the recovery?

Losing hope this will fix itself. I was feeling great until a small cardio session in the gym last week. What ever I did flared it back up and I feel like I’ve just undone 3 months of progress. Doctor talked about the surgery, he’s not ready to recommend it fully but I’m ready to be over this.

To your question, I’ve never had that surgery and don’t know anyone (friend, family or patient) who has.

Personally, if this was my Achilles, surgery would be the absolute last resort.
Here’s a list of things I would personally look into and likely try before doing “exploratory surgery”
- High end PT with sports medicine experience
- Electoshock therapy, therapeutic ultrasound, or iontophoresis (using e-stim to drive topical medication into the tissue).
- Prolotherapy or even better, PRP injections.
- Tenex procedure

Before ever considering “exploratory surgery” I would absolutely get a second opinion from a highly qualified sports medicine physician or orthopedic surgeon and I would be willing to travel a ways to do so.

So sorry to hear about your setback, but please don’t let frustration or fear lead you to make a hasty decision that could have life-long complications.
 
To your question, I’ve never had that surgery and don’t know anyone (friend, family or patient) who has.

Personally, if this was my Achilles, surgery would be the absolute last resort.
Here’s a list of things I would personally look into and likely try before doing “exploratory surgery”
- High end PT with sports medicine experience
- Electoshock therapy, therapeutic ultrasound, or iontophoresis (using e-stim to drive topical medication into the tissue).
- Prolotherapy or even better, PRP injections.
- Tenex procedure

Before ever considering “exploratory surgery” I would absolutely get a second opinion from a highly qualified sports medicine physician or orthopedic surgeon and I would be willing to travel a ways to do so.

So sorry to hear about your setback, but please don’t let frustration or fear lead you to make a hasty decision that could have life-long complications.

Any tips on researching and finding the best doctors and PTs to visit?

I’m striking out. Reached out to family in the medical field, reached out to family friends who coach high school and college athletics etc. not many good tips. No luck on the google.
 
I am going to chime back in on this one. Totally agree, surgery should only be if needed, and at this time it doesn't seem that it is. When I ruptured mine, I researched PT & time vs surgery. Surgery was what made sense to me since it was fully ruptured. I am pretty positive I would go that route again, but way more intentional about the PT.

In your case I would figure out how to rehab the hell out of it with a sports PT. I did not the first time as the site I was referred to wasn't as progressive, but ended up going back and starting PT again at an athlete centered facility. They take care of a few of the local sports teams. Looks like you are in Idaho; find out who treats skiers in your area or where the local colleges would go.

I also heard a podcast by Steve from EXO MTN where he had been doing some stuff to rehab his achilles area. Maybe give that a listen and see if the exercises are similar to what you've done. He said he has been having luck with it.
 
I’m striking out. Reached out to family in the medical field, reached out to family friends who coach high school and college athletics etc. not many good tips. No luck on the google.

Any tips on researching and finding the best doctors and PTs to visit?

I’m striking out. Reached out to family in the medical field, reached out to family friends who coach high school and college athletics etc. not many good tips. No luck on the google.
If you are in Boise, Mike Devitt or Katie Duke are good and will work to get you back out on the trail.
 
Any tips on researching and finding the best doctors and PTs to visit?

I’m striking out. Reached out to family in the medical field, reached out to family friends who coach high school and college athletics etc. not many good tips. No luck on the google.
PM sent.

In general, for others following, I agree with posts above. You want to find the orthopedic providers and PT’s that are treating high level athletes. Word of mouth is usually best way to learn who that is.
 
If you are in Boise, Mike Devitt or Katie Duke are good and will work to get you back out on the trail.
I’m on the eastern side of the state. Been looking in Boise and SLC though.

Talked to Mtn Physio in SLC at the western hunt expo. Been considering the drive down to him but haven’t committed to that just due to the time and monetary cost.
 
Have any of you ever experimented with an ankle brace to help?


This recent flare up is probably the worst I have ever had. Walking barefoot in my house is painful. Walking around in my running shoes is significantly less painful. I’m wondering if a brace like above would help or if it is just snake oil.
 
Eccentric weighted calf lowers helped a friend with similar issues when nothing else would
This and progressing to higher hops on my toes (like jump rope) to build tendon resilience and strength. Also working on tibialis strength and tibia rotation, plus knees over toes mobility and working on foot arch strength. Also hamstring and soles strengthening. I've also added heel wedges in my hunting boots to increase heel elevation and have ditched zero drop shoes for daily wear. Have to look both up and down the chain as others have suggested.

I had crippling Achilles tendinitis a couple years ago and have kept it at bay by regularly doing these exercises.

Studies i found on surgical intervention for non ruptured Achilles suggest that PT has a substantially higher recovery rate than surgery, with lower likelihood of future rupture or complications.
 
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