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Sunday, May 8, 2016

Aching Achilles?

A photograph of my right heel:

Maybe yours looks like this. My left heel looks basically the same. The bump in the blue oval is caused by a bone spur underneath the Achilles tendon, and it has the effect of stretching the tendon in a manner similar to the bridge of a violin:

Well, not so dramatically, but you get the idea. Problem is, Achilles tendons don't like to be stretched like that. Inflammation of the Achilles tendon, called Achilles tendinopathy, can be quite painful. And this is a problem that I've fought for seven years. I've learned a few things about the problem and how to manage it, so I'll offer these in case you might find something useful.

But first, the inevitable disclaimer: I am not a physician, and I do not practice medicine. My story may not be applicable to you. All your medical conditions should be evaluated by a physician or other qualified and licensed provider of medical care.

My initial reaction was to see an orthopedics MD, who x-rayed the ankle and diagnosed the condition. He said that surgery to remove the spur is a last resort because the rate of failure or complication is significant, recovery is lengthy and difficult, and the spur might grow back. He was reluctant to recommend an injection of steroids because of potential complications also. Instead he prescribed oral steroids, which helped immediately to reduce the inflammation. But long-term oral steroids are to be avoided whenever possible. Next he recommended physical therapy, which I tried for four months and consisted of two treatments: stretching exercises and additional steroids infused via iontophoresis. I found that the stretching exercises made things worse, and the iontophoresis was less powerful than the oral steroids. Besides, PT was expensive, time-consuming, and inconvenient.

During and after PT, I figured out a few things on my own:

  • Shoes matter a lot. Thick-heeled shoes help because they elevate your heel and relieve tension in the Achilles tendon. Flat-soled shoes are your enemy. Don't bother to fix flat-soled shoes with inexpensive inserts that you can buy at a drug store; the fix won't work. Just get new shoes.
  • When your tendinopathy is acute, minimize the amount of time you're on your feet for a few days. It's not the time to visit an art museum or walk on the beach. Postpone those until you're better.
  • Don't go barefoot, even inside the house.
  • Pain relief cremes are helpful. The one that works best for me, Movelat, is available only in Europe. But Aspercreme and its equivalents work too.
My next visit was to a podiatrist that my family has had very good experiences with. In hindsight, I should have gone to him first. He agreed with the diagnosis and said it's not uncommon for stretching exercises to be unproductive or even counterproductive. He agreed with my other observations and suggested two more measures. One, he provided custom inserts for my dress shoes to elevate my heel further. (I suppose I wear high-heeled shoes now.) Two, he prescribed splints to wear at night.
These look formidable, but I came to appreciate them. They stretched the Achilles tendon very gently while I slept. After six months of wearing splints, I found that I didn't need them anymore.

Obviously my condition has not been "cured" because the bone spur underneath the Achilles tendon is still present and possibly still growing. I can say, however, that for the time being these measures have reduced the condition from a substantial constraint on my activity to a mere annoyance. If you have Achilles tendinopathy, good luck and let me know what works and what doesn't for you.