Achilles Tendon tear

[Praha4]

FWIW

One of the most common hiking and athletic injuries is achilles tendonitis/tendonosis. I've had to deal with bouts of it the last 4-5 years, followed all the recommended treatments and stretching exercises. I had to cut a section hike short about 3 months ago when it got so bad I was limping the last 3 days, felt like I had a nail driven in my heel with every step.

2 months of PT have not improved it at all. An MRI just done shows a tear of the achilles tendon close to where the tendon insterts into the calcaneous (heel bone), and bone spur. After a lot of discussions with two different orthopedic doctors and my physical therapist, have gone ahead and scheduled achilles tendon surgery in 2 weeks. It's an outpatient procedure, about one hour, where they detach the tendon from the heel bone, shave off the bone spur, repair the tendon tear, and reattach it to the bone. Long recovery process ahead after surgery, it won't be much fun for at least a couple months.

Timeline: back up to last fall after I got home from a hike in Vermont, had similar symptoms, and a podiatrist gave me 2 cortisone shots in the heel, (about a month apart) and one was very close to where the MRI shows the tear. Did the cortisone shot contribute to the tear on later hikes? Not any certain answer, but I've done a lot of reading, and the evidence says cortisone shots in the heel can contribute to tearing the tendon. I knew that at the time, but wanted a "quick fix" so I could resume hiking. In retrospect, maybe it was a mistake. But the Dr said this was a degenerative problem, and the tear might have been there for some time, just become worse after the recent hikes.....

oh well, we all have much better vision in the rear view mirror


just a "Boots on the Ground" anecdote, I would tell any hikers to not get cortisone shots for achilles tendonitis. I'll share my surgery/recovery progress here as time passes. The doctor has emphasized to me to NOT rush recovery, not to put any weight on the foot for at least 2 months post-op.... I'll be using a knee scooter for at least 6-8 weeks, then crutches, then a walking boot, before PHys therapy.

[Coffee]

Best wishes for a quick recovery. I've been having some heel pain on my left foot that I believe is a minor case of Plantar fasciitis brought about by ramping my running up too quickly after a long hike. I'm patiently dealing with the situation by biking rather than running for cardio workouts but was looking into cortisone as a possible quick fix. I'll have to do more research on that if it, in fact, can make the long run situation worse.

[MuddyWaters]

Good luck.
I had a distal bicep re-attachment a few yrs ago. Tendons heal slowly, its every bit of 6 months to full recovery. A lot of muscle and strength is lost when you are immobilized.

A friend of mine completely tore his achiles once in front of 14,000 people. He was chosen to try to make a shot from half-court at a basketball game to win $1000 or so I think. When he did, his achiles tore and he just crumpled to the floor. He missed the shot too.

[Pedaling Fool]

Any idea what initially caused the tear?

FWIW, this is why I'm such an advocate of cross training, to especially to include weight lifting, it's all about toughening up the maintaining the musculoskeletal system, especially connective tissues. I've had these injuries to connective tissue before and they do take a very long time to heal if there is enough damage, but even slight damage can take a relatively long period to heal.

[garlic08]

I'd heard that about cortisone, but only anecdotally, like your case. Last time someone I know got a cortisone shot, it was used diagnostically, not as a treatment. I wish you the best in your recovery.

When I was in my late 30s, twenty years ago, I suffered badly from Achilles tendonitis on relatively short (100 mile) but heavy (50 pounds) backpacking trips several years in a row. I thought my career was over. Rather than seek treatment, I just decided to stop what was causing the injury. Then along came Ray Jardine, Lynne Whelden and others, who showed us aging hikers how to keep going with lighter loads. It wasn't until then that I could consider long distance hiking. I am also an avid cyclist and about 40 years ago, when I started getting serious about it, I often suffered from the same injury, for nearly a decade--but hey, I was young. Then someone showed me my saddle was too high. A few millimeters lower and I haven't had a problem since. My point is, for others with chronic injuries, maybe you're doing something wrong that can be fixed or adjusted--not all, certainly, but maybe some.

[Busky2]

Have you tried PRP therpy or have your doctors ruled that out? Wife had shredded hers and it was only thing that worked and it worked well.

Platelet-rich plasma (Abbreviation: PRP) is blood plasma that has been enriched with platelets. As a concentrated source of autologous platelets, PRP contains (and releases through degranulation) several different growth factors and other cytokines that stimulate healing of bone and soft tissue.

[colorado_rob]

Thanks for mentioning that PRP therapy Busky, I'm going to mention it to my sport doc. I'm suffering from a semi-chronic bout (about 6 months) of Achilles tendonitis as well, really getting me down. I've been through 6 weeks of PT with no improvement, now going to try a 4-5 week "rest" period (very limited walking/hiking), major bummer, have to resort to swimming and paddling, even biking tends to aggravate it. No advice from me except to say this really sucks!

Most prevalent in middle-aged males... I'm 59, the OP is 60, hmmmm.... seems to be a trend!

[q-tip]

For me, both knees patellar takedown, two complete shoulder rebuilds. Tendons are extremely slow to heal. Ice, anti-inflammatory, and patience worked for me. Six months on each knee, nine months on each shoulder. I feel for you. Without proper rehab, this issue will plaque you for the rest of your life, but the good news, a properly rehabbed tendon will completely heal.

[Praha4]

hi Busky, that's an excellent point, thanks for bringing it up. PRP can work for some achilles tendon injuries. Wee discussed PRP therapy, cuz my physical therapist mentioned it. My ortho Dr says they do PRP for achilles tendonitis/tendonosis located further up the tendon. My problem was insertional achilles tendonitis/tear, less than an inch above where the achilles tendon actually inserts into the calcaneous bone, and he says PRP just doesn't show as good results in the lower zone of the tendon adjacent to the heel. It does show promise for achilles injuries higher up the tendon.

We talked about even continuing passive therapy, walking boot for a couple more months, more ice/stretching/TENS, but after a couple months, the Dr said I will likely still have the tendon tear and pain. And even now, if I wear a walking boot for a few days, it fells a bit better while I'm wearing the boot, but as soon as I take it off, the pain returns.

recovery from this sort of surgery will take time and be slow, there's not much natural blood flow to the achilles tendon to begin with, so that's why the Dr has emphasized to me the importance of not putting weight on the foot for at least 4-6 weeks, the microbiology of healing in that area requires time for the tendon/bone tissue to grow back together without placing stress on the interface area. He likened it as somewhat similar to the rotator cuff, where the body puts very large stresses on small areas of muscle, tendon and connective tissue.

thanks for the comments

injury prevention and treatment should be a major topic on WB

Have you tried PRP therpy or have your doctors ruled that out? Wife had shredded hers and it was only thing that worked and it worked well.

Platelet-rich plasma (Abbreviation: PRP) is blood plasma that has been enriched with platelets. As a concentrated source of autologous platelets, PRP contains (and releases through degranulation) several different growth factors and other cytokines that stimulate healing of bone and soft tissue.

[Praha4]

Update.

Had the surgery this past Tuesday at Andrews Orthopedic Institute in Gulf Breeze, FL, by Dr. Dan Murawski. Great orthopedic surgeon. It was outpatient surgery with general anesthesia, surgery time approx. 1.5 hours. He repaired the torn achilles tendon, shaved off the bone spur on the heel, and did some lengthening of the tendon with reattachment to the heel bone. My foot and lower leg are in a splint from toes to knee. Non-weight bearing for 6 weeks after surgery. I return to have stitches removed in 2 weeks, when they replace the splint with a foot/ankle cast. I'm using crutches and a knee-scooter, which actually works better than the crutches.

They gave me a nerve-block injection before surgery, so the lower leg was completely numb for first 24 hours, when it wore off the pain was rough. But it's been 4 days since surgery and the pain is getting less each day. They gave me a script for Lortab, which I had to take these last 4 days, but hope I can stop taking that junk by end of the weekend, and just use Advil.

Dr said the surgery went well, and really emphasized laying on the couch or bed, and keeping the foot elevated above the heart to prevent swelling and blood clots post-op. Using ice packs at the lower thigh also every 2 hours helps control swelling and pain. His strongest advice was to NOT put any weight on the foot for the first 6 weeks, which I'm getting used to, it's hard at first but the knee scooter really helps with mobility.

So I'm getting lots of time to watch movies and read books.

Report filed from sickbay, this 15th day of August, 2015.

[MuddyWaters]

Good luck.

After a couple weeks post surgery on my bicep attachment i was allowed to get incision wet. Soaking in a hot tub felt fantastic, and i could move the arm around in the water because it was nearly weightless. Dead skin floated off the arm(i think betadyne kills it), and washed away that rotten smelly funk .made me feel 100% better.

There was a tendon surgery repair forum i spent a lot of time on while laid up .

[v1k1ng1001]

The only remedy for tendonitis is rest. On the other hand, the best defense against tendonitis is to get some regular high impact exercise. I spent many years cycling and I would cross train with trail running to maintain my bone density, ligaments and tendons. Nowadays I play basketball four days a week which is hard on the joints but great for maintaining connective tissue.

Sent from my SM-G900V using Tapatalk

[camper10469]

Got dam I feel your pain! Same thing here, the spur is at the insertion n notiung has made it better in 2 years... you got me by 2.

Sux being out of action for something so stupid. Why cant they just shave the spur with out detaching it? Hurts like hell on bad weather days especially!

Get the surgery n let me know how it goes... I may wind up doing the same.

Good luck buddy!

[camper10469]

I didnt see the update.. gunna read it now.

[Country Roads]

Some antibiotics have a warning about possible tendon ruptures. If you have had tendonitis (more acute problem) that was not dealt with, it leads to tendonosis (chronic problem) which can cause cysts at the Achilles tendon attachment. This can thin the tendon and make it susceptible to rupture. If you have the surgery, do the post-surgery routine and rehab. Do not rush it! Surgery can be a great fix if you follow doctor's orders for post-recovery. No I am not a Dr. nor do I play one on TV. Have had my own problems with Achilles and Peroneal tendons.

[Praha4]

Update #2
Achilles tendon debridement w/removal of heel bone spur. Outpatient surgery on 8/11/15

I wore a foot to knee splint the first 2 weeks post-op, to allow for foot swelling after surgery, and my foot was positioned slightly "toes down" with the splint in place.

They removed the splint, and removed the sutures at the 2-week visit. Swellling had gone down a lot, but still some swelling and pain in the heel area, to be expected. They put me in a cast from foot to the knee, with foot in neutral position. I remain Non-weight-bearing (NWB) for 6 weeks post-op, using a knee scooter is much easier than just using crutches. Doing some simple stretching exercises at home (knee to chest while lying on floor, simple leg lifts to 45 deg position while lying on floor... 3x a day)

Return to the Foot/Ankle Orthopedic surgeon tomorrow for my 6 week post-op visit. IF everything looks okay, I was told the cast will come off and I will start using a "Fracture walker" boot for the next 1-2 months, and possibly begin physical therapy soon.

This is the point of the recovery process I'm very nervous about to be honest. During the last 4 weeks, while being NWB and using a knee scooter, I've had a couple instances where my knee slipped off the knee scooter, and had to put weight on my toes for a moment, which caused pain in the heel area for a day or so. So I'm nervous to see what the Dr says tomorrow on this, and if he thinks I need to stay in a cast longer. Healing at the achilles tendon/calcaneous junction is slow to begin with because it's a part of the body that does not get much blood flow. So I already know this recovery will go on for at least 6 months or longer. Yeah, it's a bummer, but when I think of people like our war veterans who have prosthetics, i can't complain.

if anyone ever goes thru this, I highly recommend the knee scooter, but you need to remove any "area rugs" from your house, which become slip/trip hazards (happened twice to me).

will give periodic updates, this is a new one for me

[Praha4]

Update #3: 7.5 weeks post-op for torn achilles tendon & heel bone spur

Doctor removed the cast at 6 weeks post-op. Been wearing a "fracture-boot" (walking boot, knee to foot) for last 1.5 weeks. Foot swelling continues to go down, but still some swelling. Doctor says this will take more time to go away.

The Dr gave me a simple set of 'range of motion' and green thera-band exercises to do at home 3x a day. He also put 2 heel pads in the walking boot, so my heel is elevated to keep some tension off the achilles tendon-heel bone while it heals. Each day begins to feel a little better, but lots of patience needed. Some heel pain still comes and goes depending on how much walking I try to do. Too early for an exercise bike also.

Return to the Dr in 2 weeks for a follow up and see what's the plan. Hoping to begin some more aggressive physical therapy at that point.

Surgery site has healed up well, little sign of the incision now, but the foot swelling is a pain. Elevation of the foot, ice packs and compression socks help some.

will give periodic updates. catching up on movies and reading books!

[donthaveoneyet]

I've been following this and I feel for you. I managed to get a small tear in my right Achilles tendon a couple of years ago, while hiking. Mine was higher up (non-insertional), and the docs did not recommend surgery - just rest (ugh). (I tend to agree the cortisone was not a great idea, based on what I've been told). I was grounded for months. I have been very cautious building it back up. I started with 3 mile loop "hikes" using a light pack, and gradually built it up. I still get some swelling and a little pain if I do more than 10 miles or so at once. But it's manageable (I think). I just posted a question about boots in the general section, would be interested to hear your thoughts or what you've been told about footwear.

[Second Half]

Thanks for sharing your experience.

I've had heel pain off-and-on for years. A year ago I had to cut short a weeklong hike and finally went to a doctor. X-Rays showed what was described as Haglund's deformity, which sounds similar to your bone spur (was Haglund's mentioned to you?)

The doc said it won't get better without surgery. He was right, I'm still limping a year later. Unfortunately my job is such that it'd be impossible to be off the foot/limited use for months. Sigh.

Best set of luck with your continued recovery.

[lemon b]

Your sharing of your injury and complex recovery process is appreciated. When we are blessed to get some years in on life sure does take time to get back to normal. Find your experience with the cort. shots to be very interesting as I could see myself also being the type to go for the quick fix in order to get back into action. Father time always wins in the end. However, as a general rule I believe we hikers age slower than the average person.

My positive thoughts and prayers are with you. We are not kids anymore.