Achilles Management
I put together a list of tricks that helped me in my 3 years of dealing with chronic insertional achilles tendinopathy. I continue to rely on some of these methods as I rehab from a bilateral procedure that removed my Haglund’s deformities and debrided my achilles tendons.
*I am not endorsing any of these practices… I am simply sharing them as methods that have been helpful to me. Please consult with a doctor or physical therapist before trying anything.
Mobility
Band-assisted ankle mobilizing helps my ankle joint glide and move better when there is stiffness in the joint caused by inflammation in the achilles and bursitis. Get a taut looped band to loop around the front of the ankle and put that foot up on a slightly elevated surface, like a stair. Loop the other end of the band around the bottom of the other foot and stand firmly on that part of the band such that there is a lot of tension around the front of the ankle that you are mobilizing. Push your knee forward and hold for a few seconds, and then slowly move the knee back. Repeat 10x on each side.
After mobilizing with a band, the knee-to-wall mobility test is a classic. Stand in a split stance a few inches away from a wall. Try to push your front knee forward until it touches the wall. If this is too easy, scoot your foot back a half inch. Keep scooting the foot back until you can just barely get your knee to touch the wall (NEVER push through pain and stop if it is painful). This should be easier after doing band-assisted mobilizing like above. Hold the stretch 2x30 sec each side. This is a good way to test dorsiflexion and to increase mobility. This is more of a stretch for the front ankle but the back ankle/calf gets a good little stretch too.
Calf Strengthening
There are many different exercises and variations to strengthen and load the calves. Here is a go-to starter one. Start with bodyweight and slowly increase to holding different weights (can progress to wearing a backpack with weights… I even do this while holding my teammate on my back!) Once again, this should not be painful and if it is, you should stop. Stand on one leg on the edge a stair with your heel hanging off. Hold on to the wall or railing with one hand for balance. With your knee slightly bent, slowly raise up onto the ball of your foot as high as you can (or until pain in the heel stops you). Then slowly lower your heel back down as low it can go (past the edge of the stair, as long as it is not painful). Do 3 sets of 15 reps on each side. Progress to more reps and more weight as this becomes easier.
Anti-Inflammatories
There are different kinds of anti-inflammatories that can be helpful. Over the counter NSAIDs like ibuprofen can help for mild short-term relief. You can also ask your doctor about prescription strength NSAIDs like Meloxicam, which has provided significant relief for me when the pain and inflammation was really bad. This should not be relied on as a prolonged solution but can help calm down temporary flare ups. There are also topical NSAIDs like Voltaren gel that sometimes provides short-term relief. It used to be prescription-only in the United States (we always stocked up on it in Europe!) but it can now be bought over the counter as an “arthritis” treatment. You can purchase on amazon here. For a natural topical anti-inflammatory, I love this CBD cream, which you can buy here.
Iontophoresis
Iontophoresis is a method to deliver a topical medication called Dexamethasone. The underlying tissue absorbs the medication through electrical currents. Read more about it here. You can usually get this administered in a physical therapist’s office (there is a portable patch version and a version that is connected to a machine). You can purchase the portable patches here, but you should always consult with a doctor or PT first.
Heating and Icing
Never underestimate the power of hot-cold therapy. I used to always heat up my feet/ankles in a sink filled with hot water for about 10 minutes right when I got up every morning. Tendinopathy/tendinitis usually feels the worst first thing in the morning... the pain and stiffness made me dread getting out of bed. I would sit with my feet in a sink filled with hot water and do ankle pumps and circles to warm my feet up.
After exercise, I do a hot-cold contrast soak on my feet/ankles. 3 minutes in an ice bucket, 3 minutes in a bucket with hot water… and then repeat 2 more times.
I have a gel ice pack like this that I wrap around my heels for 10-15 minute after exercise, and then again later in the day. Be careful not to give yourself ice burn by leaving it on for too long or if it feels too cold on your bare skin. This one on amazon can be used as an ice pack or heat.
Heel Lifts and Inserts
Off-loading the achilles just a little by putting a heel lift or insert in your running shoe can make a big difference. Always be careful when making adjustments like this to your shoe and ease into it. Here are my favorite heel lifts and inserts.
Shockwave Therapy
Shockwave has some significant research supporting its efficacy in treating insertional achilles tendinopathy. I found I had significant short-term relief from it. It is more common in Europe but some PT clinics in the U.S. can administer it. I had about 7 treatments spaced one week apart and noticed some relief from the pain and stiffness. Read more about insertional achilles tendinopathy and shockwave treatment here.
Source: Buxton Osteopathy
Saline Injections
Saline stripping/hydrodissection of the peritenon essentially creates space between the irritated tendon and the heel bone so that the joint can glide smoothly and pain free. A salt water solution is injected behind the heel bone and the needle is used to scrape away the neovascularizations that are so painful in tendinopathies. It is an ultrasound guided procedure administered with a local anesthetic. Sometimes a small dose of a steroidal anti-inflammatory is included in the injection, though this has risks of weakening the tendon for tearing. It is a more common procedure for the mid-portion of the achilles, but I had a lot of success with it at the insertion of my achilles. Here is a video explaining the procedure.
Tenex
Ultimately, I decided to have a procedure to remove my Haglunds Deformities. If these weren’t addressed, I would continue to have heel and achilles pain. Tenex is a minimally invasive technology that removes unhealthy tissue (in both bones and tendons) through ultrasonic energy. Read more about Tenex here.