Achilles heel issue

[tasadam]

So... Would you get it done?
http://footsurgeon.com.au/fa-conditions/achillestend (not the first image - it's not Haglund's).
I've come to the point where I have decided I have to, because every step, every day, is painful and has been for a long time. Right heel has been inflamed and painful for a few years now, lost count really. Bushwalks are among other things a pain management exercise.

Anyone had anything like this done before? How did it go? How do they find the scar tissue in the boot? I could probably spill a million questions, but rather just thought I'd put it out there to see if anyone's got any input.

They want to detach my achilles from the bone, remove the bursa (sack of fluid that's supposed to prevent achilles from rubbing on bone), chisel away some of the heel bone, clean out all the gunk (veins that aren't supposed to be growing through the tendon, and possibly some calcification) from the achilles tendon, then reattach it to the bone. Laid up for about 10 - 12 weeks afterwards I think.

I figure at the moment I can walk, so I've been putting it off. If things go bad, I worry about whether I will be able to (bush)walk. Like, walking with a bit of pain is better than not being able to, and once things get moving it's fairly constant, only needing tablets if it gets too bad, otherwise I grin and bear it.

Looking at having it done either by Andrew Beischer (site linked above) or Andrew Kingsford - a Podiatric foot and ankle surgeon.

Anyone with any advice?

[Nuts]

That sounds like a terrible affliction. Sorry, i don't have any tips, iv'e held them away from my knees thus far. I have an idea of the dilemma. All the best eh

[ak83]

Mate...tendinopathies are hard to rehab, and achilles surgery is heavy work! Generally the scar is on the outside of the achilles in a "j" shape under the ankle bone so shouldn't rub too much. If specialists say you need it then its definitely worth considering. I'd stick with the orthopod and not the podiatrist.

[Marwood]

My $0.02:

1. Before you go any further, make sure you have a full understanding of why you have this problem. The simplistic answer may be something like: "many years of hiking with a heavy pack". But many people have done the same who don't have this disorder. So what is it about your anatomy, biomechanics, and injury history that has lead you to this point? And more importantly, what needs to or can be done to reverse or correct these factors.

2. Before you have this surgery, make sure you clearly understand its success and failure rates, and the complications that might result. In other words, understand the risks. Get information from the medical literature, don't only get the opinion of the person who will be doing the surgery. Make sure that in your own mind, the probable benefits outweigh the possible negatives.

3. Find out what you can and should do before the surgery to improve outcomes. If this involves several weeks or months of actions to be taken, get started.

4. View the surgery as a component of a 12 to 24 month program to correct your problem as completely as possible and to restore you to the maximum possible level of function. Prepare yourself for the weeks or months of post-operative rehabilitative therapy and exercises that you will need to complement the surgery.

All the best....

[South_Aussie_Hiker]

My mother had a foot bursa removed surgically about 12 months ago.

It had been getting worse over the last 5-7 years, and by the end even just simply walking in bare feet around the house was quite painful.

Podiatrist said he could fix it non-surgically (practically guaranteed her). She had insoles made (v expensive) and went back every three months to have them adjusted. Every time she bought a new pair of shoes... had to take them to him and check if she could wear them (90% of the time he told her to return them to the store).

Cut a long story short... it helped a little with the pain, but it still continued to deteriorate rather than get better - quite a few thousand dollars wasted. She then had a consult with a surgeon who told her it was probably past the point of fixing non-surgically 3-4 years ago, and no level of podiatry could fix it, and he'd been wasting her time.

She had the operation. Was painful, but wasn't laid up as long as you will be. The improvement has been remarkable - couldn't walk around the block before, now she bushwalks up and down really steep inclines.

My advice - go with the surgery. Fix it properly the first time, rather than half-fix it about 7 times over.

Oh and yeah... achilles do not heal fast. You could potentially be out of hiking action for >12 months.

[Macca81]

Have you looked into barefoot walking/running? I'm no doctor but i have had achilles problems in the past. I have begun going barefoot more and more lately and although to start with it made my achilles and calves ache, they began to strengthen up and the pains that i used to have is virtually non existent now. The human foot was never designed to have a raised heel, a few million years of evolution couldn't have been too wrong... Look into it perhaps?

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[johnw]

Oh and yeah... achilles do not heal fast. You could potentially be out of hiking action for >12 months.

2nd hand info, but a close work colleague in his mid 40s tore his achilles playing squash. Had to have emergency surgery to sort it out, so there was no opportunity to evaluate options etc. He had all sorts of recovery problems but eventually it came good after 18 months or more. Still has a few issues but now pretty much back to normal. He was/is active as a distance runner with some occasional bushwalking (he completed the 100km Oxfam Trailwalker before the injury and is considering attempting it again next year). He was able to complete his first marathon earlier this year; so while his experience was a long and sometimes difficult recovery, there has been a positive outcome.

[South_Aussie_Hiker]

Yeah John, it's a long road back with any Achilles damage.

My wife strained hers on the Overland track in 2009 (on the last day from Echo Pt to Cynthia Bay). Doctor said it was just a slight strain - took 4 months to come good.

[Tofu_Imprint]

Well you know a bit about my Achilles issues already Tasadam, but for the benefit of others (and myself), I'll outline it a little.

In New Zealand I got achilles tendinopathy on a 80km hike. I knew something was up, it was extremely painful to walk, Voltaren did nothing etc.
When I got back to Australia, I saw a physio (still seeing physio). It was a moderate case apparently. It was around 4-5 weeks of physio before I could actually walk without too much pain. I was given exercises to do every day and every session we would try to ramp up the exercises if I was improving.

I did/do alot of stretching every day now, amongst other exercises. I have also had dry needling done by the physio and ordered custom orthotics (turns out I needed these anyway). They are not cheap at $390 (from Canada).

I currently have no pain usually, after being back at work this week I have noticed some pain at the end of a physical day in my right foot only. I also have this 'cracking' in my achilles/heel region that is recurring and I never had it previously. If it persists until next week I am supposed to get a referral for an ultrasound. I believe it is another injury related to the tendinopathy, it causes extreme discomfort during strenous activity, and mental annoyance because I don't know what is wrong. I will get that checked ASAP. I did have an xray for bursas but nothing turned up.

Overall, it was/is debilitating. I question whether or not it will be recurring? Even with the exercises and my good level of fitness. I hate to say it, but I believe I will eventually end up in your shoes Tasadam.

Either way this is a relevant and helpful thread, so please keep us posted on what you do.

[davids]

I haven't had achilles tendinitis, but did snap my achilles when I fell rockclimbing. It was a really annoying little fall, but my foot was wedged and my whole weight went onto the achilles. The drive back from Arapiles to Gippsland to get fixed up next day was interesting! Lucky I had an automatic.
The achilles has healed well - the orthopod assures me its stronger than the other side now - but annoyingly the shape of the back of my ankle is different, and the skin somewhat tethered and thickened and I inevitably get a huge blister every time I go hiking now. maybe I should get a new set of boots, but that would be like getting a new wife - I've had boots (and wife) for over 20 years and don't want to change either.

[flyfisher]

Adam, I did some damage to my archilles on a Strollers walk up to Cathedral mountain abuot 18 months ago. I had never had any trouble with it before bu it persisted for 6 months or more. My archilles became swollen in the lower calf area and the pain was severe.
My self treatment was stretching and tip toe stands in the shower every morning. Started with about 30-40 but after a month or 2 the number became just till I was bored of repetitions.
Improvement was slow but it has improved a lot.
I think the initial cause may have been setting off uphill with no warmup after 3 and a half to 4 hours driving from Hobart ,and stiff boots and a heavy pack.
Age at the time (65) probably didnt help or the 18kg pack.

Whaterer you decide Adam I hope you have a good outcome.

[Rob A]

Hi,
My advice would be indirect but;
Find the best physiotherapist you can get on to, and if they are the best then wait for that appointment. They should be sorting out elite athletes and ballet dancers.
They will be seeing the results of a number of orthopaedic surgeons work, and probably be working hand in glove with the better surgeons for their patients rehabilitation.
The physio should be able to short list the surgeons (and probably radiologist), and give you a very good idea of what you can expect from both physio and surgical options. Listen hard, its the consult.
Then hit your general practitioner and ask him for the referals you need.
The surgeon will tell you straight up whether with your specific injury and lifestyle, he can make it better than it is, and what your window for surgery is.
It gets pricey but hopefully you have private cover becasue surgery these days can be so good its better than a holiday, as opposed to the dickensian of twenty years ago.
Anything involving soft tissue and tendon work wouldnt be unusual for a period of immobilization for the wounds to heal before loading up, a pretty quick recovery thereafter to usefull, but a couple of years back to maximum.
It makes a huge differene to get onto the guys at the top of the game. Get it done right, the chances are whatever you get done has to last another forty or fifty years.
Rgds

[tasadam]

Thanks to everyone who has provided input, I appreciate it.

Here is the issue...

November 2011

[tasadam]

I should also mention that I have been down the long road of physios and podiatrists, inserts and orthotics, stretches and strengthening exercises, referrals to specialists and trips to Melbourne to get MRI's done using the most advanced technology available, and two assessments of the results, both recommending the only way forward from here is pretty much the same surgery. One mentioned the possibility that the tendon may need to be supplemented by a tendon from somewhere else ( ), the other difference was that of the reattachment to the bone, using some sort of a wedge thingy to staple it into the bone as opposed to stitching it there (or something like that)... Memory of the descriptions has faded a bit but I still have all the notes.

The flexibility of my ankle etc is above average and the same in both feet.
The likely cause is the bone that sticks out at the heel is bigger than normal, a spur perhaps, can't remember.

The recovery will be about 10 to 12 weeks of no load bearing, after which the calf muscle has pretty much wasted away, then it needs building up again. Full strength estimation 12 months, obviously a lot of factors in that.

[Wingnut]

This won't help you at all...

From my experience, & I've strained my Achilles so many times during 20+ yrs of cycling. Usually from not stretching enough prior and or hyperextending, basically now days I make sure I stretch an hour prior to any activity and stretch front and back of the leg muscles evenly. If I did feel my Achilles pulling tight I'd stretch my calves which would release any tension on the tendon.

When I have had a bad strain it was usually total rest, no activity at all to allow the tendon to rest then recover. Only once did I keep at it during an injury but my alternative activity was surfing so it wasn't a repetitive ongoing strain.

Your heel looks pretty nasty and too far gone for anything but surgery, I'm sure you have had a great deal of advice already.

Good luck with the injury & hope you have a speedy recovery...


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[tasadam]

Well, time for an update. I've got a date for surgery, and I an indeed going with the Orthopaedic surgeon.
I went to see him earlier in the month and had another MRI done. I still don't know whether he wants to rob the tendon that bends the big toe down, to help build up the Achilles. Guess I'll find out after the op.
Thanks for all the comments and suggestions, I'll let you all know how things are going once the deed is done. Some time to go yet, so now planning what will likely be my last big walk before the op (with plenty of analgesics in the pocket).

[South_Aussie_Hiker]

Best of luck!

[tas-man]

Well, time for an update. I've got a date for surgery, and I an indeed going with the Orthopaedic surgeon.
I went to see him earlier in the month and had another MRI done. I still don't know whether he wants to rob the tendon that bends the big toe down, to help build up the Achilles. Guess I'll find out after the op.
Thanks for all the comments and suggestions, I'll let you all know how things are going once the deed is done. Some time to go yet, so now planning what will likely be my last big walk before the op (with plenty of analgesics in the pocket).

How is your recovery progressing tasadam?

[tasadam]

A long and detailed reply will be coming, but in short it's currently a lot better now than it was before the operation.

[Ent]

Sounds very similar to mine. Though right one actually improved during an OLT walk.

Did the usual round of specialist and was left with the impression as bad as it is there is worse outcomes.

As for pain management. Well very anti pain killers (for another reason) so my approach is "suck it up princess". But also means I have long stopped running so general fitness has suffered and I miss not doing the Burnie Ten but days hobbling around after a short run just not worth it.

One less invasive treatment is a blood patch. This falls a little into voodoo medicine but some medicos claim it can help. One day I might buckle and go for it.

Cheers