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Old 06-30-2010, 06:06 PM   #1
Eric Aldred
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Exclamation Achilles Tendonitis or Posterior tibial tendon dysfunction

This started about 3 weeks ago after a long, challenging hike. I didn't really notice it in the first week, because I have been treating a Peroneas Longus strain and Plantar Fasciitis in my left foot. I have been CF'ing since last August as a means for preparation for joining the army (shipping this September, even more the reason why I need to head this off with a quickness). When I started, I was severely overweight (6'3" - 305lb ex collegiate defensive end who let himself go ). I have since lost 85 lbs through the early adoption of a pretty strict 90/10 paleo diet, and a slow build on my training (went from 1 on 1-2 off to now 3 on 1 off with some CFE workouts sprinkled in at least once a week). Only reason I mention any of this is because it is probably important to understand that my body has gone through some massive composition changes in the last 9 months, so these sorts of injuries are not surprising to me.

Anyways, here are my symptoms. General soreness in my right foot (attached a picture to show exactly where the pain is concentrated). Pain is onset when I run/jump or perform any explosive movement, and then seems to fade as I go through my warm-up, and is generally gone by the time that I cool down after the WOD. But, there is dull pain to the touch, and sharp pain to deep pressure (say, from when I massage the area with a golf ball).

Pain - as described above. There was redness for a while around the area circled in the picture, and I do not believe I ever had swelling occur
Severity - 3-10 when warming up. 8-10 when I initially massage with golf ball lowering to a 1 after 15-20 min
Position - pain seems to move up and down the circled area. pain does not ever seem to be actually on the back of foot where Achilles is
Provokes - from running/jumping or explosive movements. no pain from walking unless already aggravated. I am a slight heel striker, but have gotten better at striking in the mid foot/front foot.
When pain presents - what distance did it present? Pain in morning now?
Running history - I run 1-2 times a week outside of WOD's as Rx. Generally, if I am not doing speed work, I will run distances of between 3-5 miles. NOTE - I bought my running shoes when I was a moderate-severe over pronator. They are very much broken down, and have been for probably the last couple months. I replaced them 2 days ago at my local running store, and also picked up some green superfeet to help with my PF and for better arch support.
Shoes - Running shoes were Men's Nike Zoom Structure Triax+12. now are Brooks Adrenalines w/green superfeet insoles. I WOD in Adidas Scorch Sport TR's (going to put my superfeet in those when I am not in my running shoes)

Age? 26
Medical history - Medication? Ibuprofen, Multi-vitamin and fish oil. Arthritis? no. Knee problems/pain?no. Back problems/pain? sometimes after a taxing workout, but nothing lingering.

Functional tests - One leg balance time? stopped at 2' on each leg. Elevating onto both sets of toes with minimal support? fine, no support needed. Elevating onto affected foot's toes with minimal support? fine, no support needed.

Current Treatment - resting for 2 weeks. Incorporated suggestions that I have read up on this forum and the eatmoveimprove articles that Steven Low shares. Such as (since I started resting last Friday) PNF stretching calves/quads/hams, Foot drills (toe/side of foot and heel walks), heel drop drills, ankle drills, general flexibility improvements (made up a whole flexibility improvement complex with one of my box's trainers), foam rolling, four corner balance drill. I am massaging with a golf ball (that's where that blister came from ), using ice cubes to massage with and I have increased my fish oil intake to 12g EPA/DHA p/day (was treating with NSAID's, after reading others here, decided to let natural inflammation do its deal).

I apologize for the massive post, but I leave for training in September, and it is of the utmost importance that I go into training at 100%. Plus, my insurance sucks. To make it worse, I have Keiser Perm; who are notorious for being generally ****ty at anything sports related. Self treatment is my only real resort. I really, really appreciate any input I can get. Hopefully someone smarter than me can tell me what it is I have exactly, so I can treat it appropriately so I don't cause any more damage.
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Old 07-01-2010, 10:17 AM   #2
Eric Aldred
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Re: Achilles Tendonitis or Posterior tibial tendon dysfunction

forgot to attach the picture, sorry about that!

NOTE - I forgot to mention that when I massage near where the arrows are pointed, I hear/feel crackling. very odd. also, most pain is concentrated in the red circled area

Click image for larger version

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Old 07-03-2010, 11:18 AM   #3
Steven Low
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Re: Achilles Tendonitis or Posterior tibial tendon dysfunction

1. Cut out everything for now except the foot drills.
2. Keep the fish oil and paleo
3. Eliminating the running for now if possible... or anything else that you're doing that's aggravating it.
4. I hope your shoes dont have padding because the foot drills stuff should help correct the problem with pronating -- basically you want flats.

If you're going to do thatyou need to drastically cut down on volume anyway.. foot drills will help that adaptation.

5. Eccentrics are you main method for eliminating the tendonitis type stuff because they are the most effective.

Go to a step and toe raise yoruself all the way up and do 7-10s slow eccentrics. If you can do one footed ones without pain all the better. 15-20 reps for 2-3 sets would be good. 3-4x per week.

Combine that with the foot drills, and some mobility work for toes/arches/ankles, and the foot drills and it ShOULD heal up better.


I need to do an overhaul of teh tendonitis article anyway I have some more stuff to add and restructing of the article anyway.
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Old 07-05-2010, 09:59 PM   #4
Jason Casiano
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Re: Achilles Tendonitis or Posterior tibial tendon dysfunction

Steve, I myslef am coming off PRP injections on both Achilles. Follwing your advice for rehab, and hoping to avoid a false feeling of being "Healed". How long would you recommend a person waits before giving it a go full throttle? At 38, all the Dr. kept noting was how I'm a prime candidate for a rupture. Not very helpful.
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Old 07-10-2010, 08:13 PM   #5
Steven Low
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Re: Achilles Tendonitis or Posterior tibial tendon dysfunction

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Originally Posted by Jason Casiano View Post
Steve, I myslef am coming off PRP injections on both Achilles. Follwing your advice for rehab, and hoping to avoid a false feeling of being "Healed". How long would you recommend a person waits before giving it a go full throttle? At 38, all the Dr. kept noting was how I'm a prime candidate for a rupture. Not very helpful.
Depends how bad it was.

In general, if you came off a procedure or something I would start out going maybe 20% at most... and then every week you're feeling good ramp up another 10-15% intensity.

Should take at least ~4-8 weeks to get back to 100%. That SHOULD be enough time IFF everything keeps progressing well.

If you get twinges here and there a lot then it's likely too fast and you'll probably have to progress slower.

Nothing is really set in stone so you gotta be willing to play around with it some; BUT at the same time be conservative because reinjury rate tends to be much higher than not because of aggressive rehab.
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Old 07-22-2010, 05:47 PM   #6
Tim Pedersen
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Re: Achilles Tendonitis or Posterior tibial tendon dysfunction

Jason/Eric - have had same thing and am in the older age group (47 yrs young from trying to do DU. How is the healing process going for the two of you and what has been working / not working? Thanks in advance.
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Old 12-11-2010, 02:49 PM   #7
Lars Henriksson
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Re: Achilles Tendonitis or Posterior tibial tendon dysfunction

Hi Guys,
My name is Lars Henriksson and I'm 46 years old. I have had Achilles Tendonitis for many years and I've tried most things in order to treat it.
I can only agree with the advice to go for eccentric training. It treats 80% of all patients within a three months period. You will feel significant results justs within three weeks.

I have written an article on the topic over at Ezinarticles. Good luck with the treatment.

Ezine Article, Achilles Heel Pain

Best!
Lars
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Treatment for your Achilles Heel Pain | Achilles Tendonitis

Last edited by Lars Henriksson; 12-11-2010 at 02:52 PM..
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Old 12-15-2010, 02:00 PM   #8
Mark Jones
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Re: Achilles Tendonitis or Posterior tibial tendon dysfunction

Quote:
Originally Posted by Lars Henriksson View Post
Hi Guys,
My name is Lars Henriksson and I'm 46 years old. I have had Achilles Tendonitis for many years and I've tried most things in order to treat it.
I can only agree with the advice to go for eccentric training. It treats 80% of all patients within a three months period. You will feel significant results justs within three weeks.

I have written an article on the topic over at Ezinarticles. Good luck with the treatment.

Ezine Article, Achilles Heel Pain

Best!
Lars
________________________________________________

Treatment for your Achilles Heel Pain | Achilles Tendonitis
Is this spam and a sales pitch?
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Old 12-15-2010, 02:19 PM   #9
Lars Henriksson
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Re: Achilles Tendonitis or Posterior tibial tendon dysfunction

Quote:
Originally Posted by Mark Jones View Post
Is this spam and a sales pitch?
Hi,
I have written a popular version of the finding in this article: The Americain Journal of Sports Medicine, Heavy-Load Eccentric Calf Muscle Training For the Treatment of Chronic Achilles Tendinosis. Håkan Alfredson, Tom Pietilä, Per Jonsson and Ronny Lorentzon. AM J Sports Med 1998 26:360

Best!
Lars
PS And yes, I have added a sales pitch in my signature.
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Old 12-15-2010, 09:35 PM   #10
Mark Jones
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Re: Achilles Tendonitis or Posterior tibial tendon dysfunction

Quote:
Originally Posted by Lars Henriksson View Post
Hi,
I have written a popular version of the finding in this article: The Americain Journal of Sports Medicine, Heavy-Load Eccentric Calf Muscle Training For the Treatment of Chronic Achilles Tendinosis. Håkan Alfredson, Tom Pietilä, Per Jonsson and Ronny Lorentzon. AM J Sports Med 1998 26:360

Best!
Lars
PS And yes, I have added a sales pitch in my signature.
Well thanks for the candor!

Mark
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