Problems with achilles tendon still

[Coffeeanytime]

I’ve had what the physio thought was achilles tendinopathy for 1 year now. I’m in so much pain every day. I can’t believe it has been 1 year and I am still not improving. I’ve had physiotherapy, exercises and shockwave therapy, none helped. It just made the pain worse. The GP refused to send me for a scan because apparently the request will be refused by the hospital due to the type of injury. They made me wait 9 months to see a Rheumatologist as they were convinced it was to do with that. The Rheumatologist was very confused as to why I had been referred to her. Apparently there is nothing rheumatological going on with me. Obviously all of the bloods were high due to the constant inflammation. Other than that, they don’t think it is anything to do with them. I have other pain in my body too, so the GP thought it might all be connected. I’m left in so much pain, I’m working full time and as each hour goes on the pain gets worse. I’ve been home for 2 hours and I can still feel the pain throbbing in my feet/ankles. I limp home after work. 8 hours on my feet at work and over an hour each way on public transport. I cannot take anymore time off sick or I will lose my job. I’ve had so much time off already due to this issue and other things. I don’t know who I need to speak to, any referral to see another specialist could be around 6 months. I wouldn’t even know which specialist to visit. Has anyone else had this? It’s both feet by the way.

Have you seen a foot specialist or had orthotic insoles fitted?

No I was told for so many months to just wait until my Rheumatologist appointment and was lead to believe they would do all necessary scans/tests. The GP was so certain it was some kind of autoimmune disease. I’ve just seen them again last week to confirm that they checked my new bloods that I had for another reason with the GP, as they popped up on the system for some reason, and they are still high, so they are confused too. I don’t know who else to see about the pain.

The physio didn’t give me anything for my feet either

You need to see an orthopaedic foot and ankle surgeon.

Provided the diagnosis is correct, and it is the achilles...

Have a look at the information from BOFAS.

British Orthopaedic Foot and Ankle Surgeons

In my experience, people who have pain for over a year despite physiotherapy, either haven't been shown the correct exercises, or haven't adhered to doing them, or, the diagnosis is incorrect, or, they have a structural issues that means the problem won't improve.

If you smoke, you need to stop, outright. One it may help, secondly, no orthopaedic surgeon is going to contemplate any potential procedure if you smoke due to a 2x risk of complications.

If you're overweight, you'll need to lose weight - not necessarily to normal, but the peak forces through the achilles are 10x your bodyweight, so if you lose 1lb, you reduce the microtrauma to the tendon significantly, multiply that by 5-10k steps per day, and it all adds up.

You may need to be pragmatic and consider a new job - I think it's going to be extremely difficult to expect the tendon to recover if you're stressing it for 8 hours a day.

Night resting splints can be helpful in combination appropriate physiotherapy - look at the Alfredson protocol, and expect it to take a minimum of three months to make an impact.

Hope this helps.

I was coming on to say this as l had the same pain and it has improved a lot with insoles. Being on my feet all day as a teacher really made it so painful so it is good to get some relief. My physio had given me exercises but it was really the specially fitted insoles that helped the most.
I hope you find a solution

@junebirthdaygirl did you buy them or did you see a specialist?

That’s the issue I can’t afford to pay to go private I already looked into this last year. I can’t move jobs at the minute due to circumstances at home my job needs to be secure.

I've had this for a year too OP, both achilles - mine's post chemotherapy. Never had any issues before.

I've been seeing a physio for about 9 months. My next appointment will hopefully include referral to podiatry for insoles (that was what was said at my last appointment - no improvement = podiatry).

Mine isn't getting better either, I've been doing the exercises religiously. At my last appointment my physio advised fewer exercises holding weights as the increase in number of exercises causes more pain. Pain that wakes me up in the night in one leg.

I sit down at work so am lucky I guess, I don't have that worry OP but I have had to stop doing things I love.

Have you asked for a referral to podiatry?

I am planning on asking for another referral but I don’t know which specialty to ask for. I genuinely thought after time it would just get better. I was wrong unfortunately.

Are you still seeing a physio? Mine will refer to Podiatry.

I think l posted on your last thread.

l was referred to a junior foot doctor. He tried more exercises but nothing helped. I’m now waiting to see the top doc as he referred me on.

Your nhs trust should have a foot and ankle clinic which has doctors in it. I second the other person though. It’s not going to improve when you’re on it 8 hours a day, no matter who sees you.

Following with interest
I have had this with my left ankle and now it has switched to my right
Sometimes keeping me awake at night - I find a hot water bottle helps
I couldn't imagine it in both at the same time
I found wearing trainers all the time helped but can't now at work

And if you’re nhs trust don’t have one, you can be referred out of area.

Gi back to your gp and put your foot down! ( not the Achilles one!)

I wrote this for you to hopefully ease the pain:

In our bodies, a cord of strength and grace
Connects our calf to heel, without a trace
Of effort or strain, it bears our weight
A marvel of design, a tendon truly great
But like the hero of ancient lore
This cord has a weakness, we can't ignore
Achilles' tendon, its name well known
A vulnerability that's often shown
A sudden twist, a careless step
Can lead to pain, a feeling we'll never forget
The Achilles' heel of athletes and runners
A reminder of how easily we're undone
But still we strive, we push ahead
With rehab, rest, and care instead
For though the pain may slow us down
We'll rise again, stand tall and sound
And so we honor this cord of strength
That bears our weight, and goes to great lengths
To keep us moving, to keep us free
Achilles' tendon, a marvel to see.

They discharged me from physio and referred me back to the GP because their “treatment” wasn’t working. The GP just kept telling me to wait until the Rheumatologist appointment. I contacted the GP again afterwards, and she said that she didn’t agree with what I told her (that the Rheumatology team told me they can’t help). This is what was said and wrote in a letter to my GP. I know this because I have access on my NHS app. They specifically said they do not think the issues are rheumatological. I’m 30 years old and I’m not overweight and I don’t smoke or drink. So the GP just didn’t even say anything just that the Rheumatologist would look at my bloods. I explained they already looming at my bloods. 3 months later they contacted me to say they are still high… well obviously they are still high. No one is coming up with an answer as to why my blood results are high and I’m in so much pain. My wrists are just as painful as my feet. Apparently I have fluid lumps in my wrists.

@DaddySolo thank you! It’s very true, our bodies do an amazing job of keeping us going.

I saw a podiatrist who recommended deep heel cups and arch support. I have high arches. I often wonder though whether I need to see someone who will fit them, there are so many types and who knows if Im buying the right ones. There are some which seem to come with little blocks and I have no idea where to put the blocks or what I should be doing with them

Plus I can only buy shoes which have removable foot beds because otherwise I cant fit the orthotic insoles inside and still fit my shoes on. Nuisance.

I also had shockwave therapy for achillies problems and thankfully it helped but that was only one one foot, the other one is now starting up.

Check whether your employer funds any treatment particularly if its actually affecting your job

Is there anything else I can do for you, I'm a qualified chiropractor and also have a degree in Feng Shui. I can show you how to vision-express yourself 😅. Anyways hope all is good :)

I had this and was fobbed off. It was all coming from wearing flat shoes/trainers Wear a small heel or an instep shoe. (or insole !) It was agony but that's the only thing that stopped it. Do the excercises for planter fascitis. It's all linked.

Mine is fine now

Hava a look at psoriatic arthritis. This is known to cause Achilles problems and you don't necessarily have to have psoriasis.

www.arthritis.org/health-wellness/about-arthritis/related-conditions/physical-effects/enthesitis-and-psa

My physiotherapist fitted them for me. Has made a big difference. Mine was so painful when l got out of bed in the morning but that's gone now.

This really helped me

I hope you don't mind me tagging you but you seem to know what you are talking about and I am getting desperate!!

I have had what I have been told is achilles tendinopathy for about 6-8 years.

The symptoms came on suddenly all at once in both ankles. On a very hot summer's day suddenly both my ankles swelled up. The swelling is at the back of ankles on both sides from the top of the heel to where my calf muscle starts. In my right leg I also have swelling up the inside of the bottom of the calf. In addition,the outside of the top of the foot right next to my ankle is badly swollen. There was no pain at all but they did feel a little stiff.

The swelling all happened at the same time and has not changed in location since it first occurred. It does sometimes get a little worse but then generally settles back to where it was.

There was no injury but during the time it happened I was in the throes of hypothyroidism awaiting diagnosis which took about 18 months. I was v unwell so was not exercising at the time at all. Since then I have been diagnosed with Graves' disease with fluctuating thyroid hormone levels. So I have been both under and over active, and have had "normalised" thyroid hormone levels, for periods of time with no change in the swelling.

In the last few years I have become perimenopausal but am now on HRT. Again this does not seem to have affected the symptoms.

At some point during this period I have also developed plantar fasciitis. But this is controlled with the use of arch supports. As long as I do this I don't have any symptoms.

I have since an MSK ankle specialist via the GP and they diagnosed achilles tendinopathy. It doesn't just seem to be my Achilles that's affected though as the swelling is also on the front of my foot as I said above so assume the issue is also affecting the tendons there. Not sure what this is called?

Anyhow, I have seen three physios and been given exercise to do. The first time it was difficult to keep up with them due to being hypothyroid and generally feeling really fatigued. They also didn't seem to be doing anything. The second time I tried similar exercises. These aggravated my PF so they changed the exercises. I followed these for weeks before giving up as they made zero difference.

In the last 6/8 months after years if no change in symptoms they have suddenly started becoming painful and much stiffer. I now get a lot of stiffness in the morning and they are painful to walk on. This dissipates as I get going but they feel slightly stiff and sore almost all of the time now.

So about 2-3 months ago I thought I needed to give the exercises another go. Again I have just found they have made the pain worse. I have combined the exercises with icing the icing definitely relieves some of the pain but over time they are just getting more and more sore stuff and painful. I have gone very gently with the exercises ti try to build up slowly so I don't think I am overdoing it. I had expected that initially it might get worse but then ease off and so I could increase the reps etc but they just seem to be getting worse and worse!

I have left off the exercises a few days as I was worried I am damaging them more and they have felt a little better.

I don't know whether to persist with the exercises or not or whether there's anything else I could try. I am also concerned that the diagnosis is wrong which is why the exercises are not working. My DH also has tendinopathy and a bump but no swelling at all. Although our stiffness and pain seems v similar.

Oh I nearly forgot, I have also tried a period of "aggressive rest" and icing and that didn't resolve the issue either. This was recommended by my DH's GP but didn't work for either of us!

Only thing I can add really is that I would normally scan to confirm the diagnosis - uss better if 100% sure it's the achilles - as jt can identify vascularity, adhesions and structural issues.

MRI sometimes better if it's potentially something other than the achilles as it shows the whole leg including bones and structures beyond where you would direct an uktrasound probe.

After the amount of time you've been suffering, id ask for a second opinion from a specialist orthopaedic foot and ankle surgeon (or another one) .

Thank you for responding, and so quickly! I'll look into getting a second opinion/MRI as you suggest. Many thanks.