UKC

Can anyone offer advice on this? Ive been trying to manage it by reducing my runs distance, intensity, running on the flat instead of hills, tried different shoes, foam rolling, having a month off running and gentle walks only, applying heat or cold, but nothing seems to be helping much.
I seem to be ok when cycling, but either walking or running aggravate it, mostly my left heel but the right also at times. I cant feel any bumps or lumps that might suggest spurs or damage.

You have my sympathy. I have been struggling with this for 3 years or so.

I have Haglunds Deformity (extra bone growth on my heels) which exacerbates it. At one stage I had insertional Achilles tendonitis and retrocalcaneal bursitis.

However, don't be miserable (!), I'm running better than ever and, whilst it still causes me problems it is manageable.

Advice for now: with insertional, do NOT do traditional calf stretches and definitely do NOT do the eccentric heel drops off the edge of a step which are often recommended for normal Achilles tendonitis. These will aggravate it.

Rather than heel drops, there's another exercise you can do which helps. You need to build up to it as it is quite strenuous. Start using both legs but eventually work up to one leg at a time. Stand on toes (hold on to a wall or something for support) and hold for 45 secs leg straight. Then 45 secs bent knee. Do this 3 times. Should take 4.5 mins. Once you can do it one legged this will take 9 minutes to do both legs (each leg one at a time).

Will post more later if I get time!

Thanks MB I agree Ive only ever had problems by stretching pretty much any muscle, hence the rolling. I think having done eccentric heel raises last year may have started this off but I didnt carry that on for long. Ill give the toe stands a go, please do post more!

Also, need to find the root cause. Could be tight calves and I've just told you not to stretch them LOL! But there are ways to stretch/strengthen feet/tendons/calves without loading them which will aggravate the insertional tendonitis.

Also, have you changed or tried to change your running style lately? Started doing more hilly stuff or increased load? Or running more than once a day? Might sound weird, but any martial arts or other sports involving jumping, twisting or spinning on feet? These questions relate to the period just prior to the injury.

Ive not been doing anything that I havent been doing for years, i.e cycling and running.

Didnt change running form and have two pairs of shoes that I rotate and replace as needed - usually 8-10mm drop. Ive given up on stretching but do foam roll, I think I was doing heel drops around that time as I thought my calf muscles were weak / tight but I have since worked out it was glutes.

You do need to do heel drops, but not where the heel goes below the horizontal for insertional achilles tendinosis. Also foam rolls your calves like mad and consider a massage gun - although I find the calves a difficult area for this. Some people recommend cross-frictional massage, but that should probably be recommended by a physio.

Other things to consider are:

Have you had any antibiotics, particularly the fluoroquinolone (such as ciprofloxacin) as these are associated with tendon disease?
Tendinopathies seem more common when you get older so strength exercises seem to be mandatory in my case and I have to work to allow the fun bit

If it is not getting better over a month as you indicate I would see the physio - there is sweet spot between no work and too much work for rehabilitation. I was surprised by my physio how much pain he thought was acceptable, but perhaps he just thought I was a wimp!

Good luck.

I had this recommended as well but also was told to repeat it for 30 seconds each stance before going running - you do feel the burn.

Eccentric heel drops BUT NOT PAST Horizontal if it’s insertional

this worked for me:

https://www.ouh.nhs.uk/patient-guide/leaflets/files/11924Ptendinopathy.pdf
 

Good luck!

Doesn't it also happen vice-versa too (ie inflammation causing bone growth)? I seem to have developed quite pronounced bone spurs, which I attributed to a couple of spells of tendonitis. 

Taking a break from running seemed to help with the inflammation. Not sure if the bone spurs are treatable. And they make all my climbing shoes feel even smaller 

Hello,

I had this earlier this year and was utterly miserable so you have my sympathies   I stopped running altogether as was concerned that I'd make it worse but that didn't help at all.  In the end (after 2 months) I went to see a physio and I'm so glad I did.  Firstly he scanned the tendon to confirm that it was insertional tendonitis (apparently bursitis can present similarly/rule out any bony spurs) and sure enough it was.  He then gave me shockwave therapy for about 10 minutes - I was a bit dubious but it has helped so much!  I also got given some exercise to do - like other people have said rising up on your toes using your good leg then bring the bad foot back to the ground slowly, around 3 seconds and repeating this 15 times twice a day both with straight leg and bent knee.  I was also told to stand on a book with toes (I use a cook book!) and put heels on floor then lean it to the wall with top half of your body and do this for 10 seconds with knees straight and then again with knees bent - for 2-3 minutes x 2.

To be fair it was only a mild tendinopathy (the physio said this several times, clearly I was just being a wuss...) but I was amazed at how well the shockwave therapy helped - literally 2-3 days later I could feel an improvement.  That was end of March and there is still a little bit of a niggle but I'm back running.  If you're in Sheff can give you name of physio

Yes, I think not resting might promote calcification and cause the bone growth. I'm injured through my own stubbornness and ignorance.

Not treatable without surgery, but that's a last resort. I've been told it's possible to get back to the point where running is pain free if managed correctly.

Ah thanks, will try it just before running as well.

Have you been to a physio? 1i had this problem for a few months a year or so ago. I was convinced I had an Achilles problem that would end my hill running for good. Saw my physio and it was bursitis caused by the hadlums deformity. I was given some exercises that isolate it before I run and now its no dramas to be honest. I'd been doing heal raises for months and was making it worse. 

Don't worry it might be a really simple fix!

I would highly recommend seeing a physio who can scan it. I developed pain and swelling at the insertion site 2 years ago. Absolute classic symptoms of insertions tendinitis and the usual heel drops prescribed by the physio. No real improvement after 18 mi the so saw another physio who scanned it. Turned out I don't have an issue with the tendon but I have an erosion in the heel bone at the point of tendon insertion. Have now been seen by a rheumatologist and am awaiting an MRI 

I've been in exactly the same boat as you - over 2 months without running and finally went to a physio last Friday. The main takeaways were that a thicker tendon (my right is still as twice as thick as my left after 2 months of no running) is not an issue for mid-grade tendonopathy and is more like hard skin on the soles of your feet; you can run with a bit of pain as long as it is 1 to 3 on a scale of 1 to 10; walking is really good rehab; rest will only get you so far and strength and conditioning are key.

So I have the same exercise as you - heel raise on both legs and lower the bad leg slowly over 5 seconds - two sets of 15 reps twice a day building to 3 sets of 20 twice a day. Also got a hamstring exercise - lie on floor and put feet and calves on a chair and raise hips - 2 sets of 15 twice a day. I can really feel it working my upper hamstrings. I also do bent knee stretches for both legs.

Fingers crossed that after 2 weeks of this I'm going to try my first (flat) run in 3 months...

Cheers

Davie

Solidarity, I had this about a year after I took up fell running. Took some time to get through it. I’ve copied posts I put on here in 2013 and 2016 so you can see what I’ve said about this when sharing my experiences previously too, but to summarise I’d just turned 30 and started fell running a lot. Then after my first first season of racing (probably did about 30 races in total) I got achillies insertional tendonitis. I couldn’t put my running shoes on, or my walking boots, or my climbing shoes – nightmare.

I’ve sorted it out now but honestly in the end I think the ‘cure’ for me was just building up much slower and never going too far/fast unless I’d really built up to in miles per week. I ran a bob graham in 2018 (I did have sore achillies after this!), wasdale in 2019 (with no bother except cramp) and am probably a bit faster than I was 8 years ago so reckon im on top of it now but I try to only run as far in one go as I have run throughout the entire week or two before. If I break this rule then I end up with a sore knee now, rather than sore achillies. I think just generally getting stronger (doing lots of steady runs in preparation for the bob graham) and staying within my capacity (I also have two small kids now so less time for running anyway) means that whatever weaknesses/instability I have doesn’t end up causing the knee/achillies problem.

Good luck!

Post from 2013: 'Didnt get much help from my GP, very unsympathetic. Eventually convinced her to send me to physio, who took one look at me and referred me to a podiatrist, who made some insoles for me (which I never wear - no good for fell running). Whole thing took about 2/3months. Went to a private physio in the meantime, combination of massage to relieve tension in leg muscles and some strengthening exercises to correct over pronation (I had a weakness in my iliacus - in my hip) seem to have made it much more manageable, although I run a lot less than I used to and it still flares up after lots of climbing/walking/running. Don't know how much that helps, but thats my story anyway. They reckon I had insertional achilles tendinopathy.'

Post from 2016: 'I had sore Achilles tendons when I was running a lot. Physio reckoned it was a result of muscle imbalance and weak hips, said he was surprised I didn't have knee pain too. I run less now (the same or maybe a little less than you), tendons don't give me any problems as a result, but I do get knee pain if I run too far quickly. A big thing that helps, and would probably have helped my tendon issue at the time, is stretching before bed and keeping muscles loose with massage. I bought a book healthy running step by step after it was recommended on here and do the stretches before bed routine and get the occasional sports massage if there's a long run or race I want to do. Somebody will be along soon to say you should really see a physio, and it's no doubt good advice, but it's expensive and doesn't give you anything to do in the meantime. I found tendonitis really painful and frustrating, so hope you find something that works for you. Thought I'd share what has worked for me a little'

Thanks everyone, have you found hot/cold to be a benefit at all?

Hi, I feel your pain, had a bad bout of this in both legs a few years back brought on by too much hill running and finishing runner up in a drunken New Year's Eve limbo competition.  As above, the eccentric heel drops are your best friend here but do them on the floor not off a step so your heel doesn't go past 90 degrees.  If you're really struggling you can even start with a thin book under your heel and progress from there.

The old advice was just to do the eccentric part of the calf raise (lift yourself up on both legs and then slowly lower on one).  However, although this managed the problem for me it never got rid of it completely.  The new science is that the calf raise is just as important, and this is what has fixed it fully for me. So I'd recommend sets of calf raises and heel drops combined, progressing from two legs, to one leg to one leg weighted (backpack).  You're trying to go as slowly and as controlled as possible.  The isometric stuff above sounds good but I never got on well with anything bent knee (puts more pressure on the insertional point).

I did a lot of hot cold when I first got the injury and it felt nice but I don't think it did anything and there's no real science behind it .  I'd focus on doing quality sets of the exercises above.  By that I mean not just bashing them out before work but taking your time concentrating on every single raise and drop.  Also good to get quality food in you after the exercises in my opinion. As above stretching is a no-no so either self massage or foam roll.  Once you have it under control look at strengthening things higher up the chain with squats/split squats/bridges etc.  Good luck!

thanks all the exercises seem to be helping