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Old 12-24-2012, 08:13 AM   #1
episodic
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Default Finally got a proper diagnosis for my 'heel' issue - problem is - didn't help much

I described my heel as making a popping feeling with every step. Something I never notice running or bicycling. Just when I walk and weight my heel (pop) and unweight (pop). I can also make it do it by grabbing a certain spot on rear bottom of my heel and plantar flexing repeatedly.

It has 'never' been painful in the least - just annoying.

Finally got a scan done.

Calcific insertional achilles tendonosis.

Seems a have part of my achilles that has had 'some' calcification near the insertion, and what I'm feeling is that mass move back and forth when weight is applied. Doc said a better description would be 'rolling' not popping.

So I know whats wrong and surgery can fix it - but the surgery is a real gripe (detach achilles - debride achilles - reattach achilles - months upon months of no activity) and no real guarantee that I will return to my previous activity level OR try conservative stuff, heel lifts, etc. Doc said it may never get worse, but it may turn into a Hauglands deformity (pump bump) someday. I rarely wear closed back shoes (I'm a huge clog fan when not working out) - so I never irritate it (good I suppose). I tend to wear birks or Naots to work.


So with this diagnosis hit me with everything 'conservative' you know of and any experiences you've seen. I'll probably hear some already told to me, but I'm here looking for experience, antedotal tales, and perhaps even old 'wive's' cures the docs won't tell me about.

Difficulty, I am a runner.


Last edited by episodic; 12-24-2012 at 09:11 AM.
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Old 12-24-2012, 02:48 PM   #2
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Achilles tendon exostosis is actually pretty common in individuals and few are symptomatic. Tendinosis itself is treatable with conservative measures - i.e. physical therapy. A lot of eccentric heel raises (i.e. double leg going up, single leg coming down), tapering of activity temporarily, stretches, and mobility work result in a pretty effective intervention. You may never stop feeling the "popping," but it will address the pathological state of the tendon (disorganization of the fibers) and will reduce pain. However, with improved mobility, I have had patients who experience a lessening or complete cessation of the rolling due to appropriate slack on the tissue.
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Old 12-24-2012, 03:37 PM   #3
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Originally Posted by SociallyChallenged View Post
Achilles tendon exostosis is actually pretty common in individuals and few are symptomatic. Tendinosis itself is treatable with conservative measures - i.e. physical therapy. A lot of eccentric heel raises (i.e. double leg going up, single leg coming down), tapering of activity temporarily, stretches, and mobility work result in a pretty effective intervention. You may never stop feeling the "popping," but it will address the pathological state of the tendon (disorganization of the fibers) and will reduce pain. However, with improved mobility, I have had patients who experience a lessening or complete cessation of the rolling due to appropriate slack on the tissue.
What is your opinion of ultrasound therapy from a chiropractor? Useful? I've been doing the eccentric thing for a while. Should I graduate to doing those weighted, or not? BTW, Don't know how many say it - I always appreciate your thoughts - Thank you.

Last edited by episodic; 12-24-2012 at 03:44 PM.
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Old 12-24-2012, 05:15 PM   #4
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What is your opinion of ultrasound therapy from a chiropractor? Useful? I've been doing the eccentric thing for a while. Should I graduate to doing those weighted, or not? BTW, Don't know how many say it - I always appreciate your thoughts - Thank you.
Ultrasound with tendonosis is good, but only if the settings are set very specifically and appropriately. The trouble is, most people don't use the calculations supported in research and just use arbitrary settings that the machines default to. Most chiropractors I've met don't utilize the calculators. Most PTs I've met don't utilize them either. I don't think it's worth what you'll pay unless you talk to the practitioner about it in advance.

Eccentric exercises should be progressive so, yeah, you should begin to weight them. You can do that by holding weights in your hands or putting some weight in a backpack. You should do 2-3 sets of 15 reps, where you begin to feel significant fatigue at rep 12-13. You can do those every day or every other day.

No worries, man. Hope it helps make your training a bit easier and enjoyable.
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Old 12-26-2012, 09:28 AM   #5
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Hmm...I get a similar "popping" on the outside of my left ankle. I've had it ever since high school (over 10 yrs), and there's never been pain associated with it. The popping comes and goes, but it is pretty constant when it shows up (planting and lifting off while walking/running).

I've never thought about getting it diagnosed and treated though. Should I?
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Old 12-26-2012, 02:53 PM   #6
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Hmm...I get a similar "popping" on the outside of my left ankle. I've had it ever since high school (over 10 yrs), and there's never been pain associated with it. The popping comes and goes, but it is pretty constant when it shows up (planting and lifting off while walking/running).

I've never thought about getting it diagnosed and treated though. Should I?
Why would you? If you don't have pain, you don't roll your ankle excessively, and it doesn't move excessively, that's not abnormal. For you, it sounds like a different problem - more likely the peroneal tendons snapping over the lateral malleolus. If it doesn't hurt, don't do anything differently.
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I am a doctor of physical therapy. Information I provide is based on subjective report alone. This frequently results in speculation and, as a result, may not always be accurate. Thus I am not liable for any action taken based on information provided.

Now offering physical therapy consultation services via Skype, e-mail, and phone. Please PM me for details.
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Old 12-27-2012, 01:01 PM   #7
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Why would you?
I don't know! That's why I posed the question . I guess episodic mentioning calcification that could possibly get worse got me wondering if I needed to worry about something similar.

Quote:
If you don't have pain, you don't roll your ankle excessively, and it doesn't move excessively, that's not abnormal. For you, it sounds like a different problem - more likely the peroneal tendons snapping over the lateral malleolus. If it doesn't hurt, don't do anything differently.
Alrighty. Thanks for the response.

And GL taking care of your foot episodic.
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Old 12-27-2012, 07:23 PM   #8
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I don't know! That's why I posed the question . I guess episodic mentioning calcification that could possibly get worse got me wondering if I needed to worry about something similar.

Alrighty. Thanks for the response.

And GL taking care of your foot episodic.
Well, it's like this - if it ain't broke, don't fix it. Sometimes, people go to the orthopedic surgeon and get things like this fixed just because they show up on imaging. Going through a surgery like that is a pretty big deal and can sometimes actually initiate chronic pain. I'm all about prevention so if you're worried about something like this, make sure you stretch your ankles, knees, and hips well to avoid these sorts of problems.
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Now offering physical therapy consultation services via Skype, e-mail, and phone. Please PM me for details.
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