Fixing the bum leg [recovering from achilles tendinopathy]

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Now that it seems that, after two years of treatments, my achilles injury has finally almost completely healed, I figured that it might be interesting and/or useful to share my story. I am of course not a (sports) physician, nor a physical therapist or a podiatrist. It is also important to remember that this is just my story, every body is different and thus every healing process is also different. Apart from that, not all factors involved in recovery of this injury are known, which means that we can’t make sure to influence all these factors, meaning that it’s not a case of “It’s your fault, because you didn’t do enough/did something wrong” if your injury doesn’t completely heal. Achilles tendinitis, also known as achilles tendinopathy, is an injury known to be very persistent and hard to treat, and I hope that my story can bring some hope to people dealing with it.

In January 2018 I would walk for an hour every day, and do low impact aerobics in my living room three times a week. After one particularly rigorous “march-and-side step”-session, I noticed pain in my achilles tendon, that subsided after resting for a day. At that point, I worried only a bit: I spent my youth figure skating and dancing, and I’ve always had a pain or some injury somewhere since I was 8. Most pains subside and are nothing to worry about, in my experience. I also know from experience that the pains that don’t subside, usually end up being extremely persistent painful injuries.

The first few weeks it looked like I was lucky: the pain did not become worse, and as long as I took enough rest, everything seemed fine. At some point however, the bump on my tendon did not disappear after resting. Even worse: the bump grew from pea sized to Easter egg sized. In May 2018 I had to admit to myself that I had a problem: I was in constant, heavy, nagging pain, and sometimes it felt like somebody stuck a knife in my tendon. I limped my way to my physical therapist who told me what I already knew: I had a severe case of achilles tendinitis, and it would take a while for it to get any better.

We pulled out all the stops: stretches, continuing to move at a low intensity (so no “bed rest”), massage therapy, kinesio taping (magical stuff!) and dry needling. Recovery was slow. Very slow. For weeks, sometimes months, there was little to no improvement. It felt a bit better, then it felt a bit worse. I tried using a night splint, that was supposed to stretch my achilles tendon during the night, but to no avail. It was only later that my podiatrist would tell me that this was due to my particular anatomy. Apparently, my type of leg is unsuited for this type of splint. Or the other way around.

I tried my hardest to stay positive and patient during this recovery process. However, the pain and the unpredictable “It’s getting better, oh wait no, it’s getting worse, it’s better, it’s not improving, it’s getting worse”-situation I found myself in, made me very desperate. I would wake up at night because of the pain, and I lost track of the number of mornings that I had to hop myself to the bathroom and the kitchen, because it would take a half an hour of massages and exercises to even be able to use my leg. I was supposed to keep walking short distances, but when you live in Amsterdam but don’t have a bike nor a car, you sometimes end up having to walk more than you should. Wearing a compression sock marketed to hikers helped to alleviate some of the pain and pressure caused by bloating. I kept stretching, my physical therapist kept treating me the best she could, but in September 2018 my recovery process halted almost completely. I decided to make an appointment with a sports physician.

In November 2018 the sports physician told me, again, what I already knew: I had a case of chronic achilles tendinitis, with calcification deposits, I had up to now done everything I should have, and everything that could be done to recover. There was only one possible treatment left: ShockWave therapy. I decided to undergo this treatment, and made an appointment for the end of November. ShockWave therapy uses high energy acoustic waves to crush the calcification deposits. That sounds like it would be painful, and it was. On a level from 1 to 10, it was about a 14. It was THE worst pain I ever suffered in my life: for 4 whole minutes, it felt like somebody was hammering a blunt nail into the periosteum of my ankle. The first two days after the treatment I was not allowed to walk, and the 12 days afterwards, I had to walk as little as possible. Here is a blog post about my experiences walking with a cane, and here is a blog post about my experiences in public transport.

At the beginning of January, it’s 2019 by now, the sports physician concluded that the first ShockWave treatment had been a success, after which I suffered my way through the second and last treatment. Recovering from this second treatment was harder than the first time, in part because my expectations were high. The first treatment had made such a difference, that I expected the second treatment to fix me completely, after which I would be done with this injury forever and could go back to landing triple Axels. Figuratively, of course. In reality, my leg still hurt, and I still had that Easter egg sized bump on my tendon, albeit smaller.

At some point, this whole situation made me so desperate that I seriously considered just having my foot amputated. Google told me that 1) this was not possible and 2) that even if it was possible, it would only make matters worse, but it does give an impression of how deeply, deeply miserable and desperate I was at that point. I did consider an operation where the achilles tendon is partially or completely removed, but as you can imagine, this has huge implications for the range of motion of the foot, and in turn huge implications for the rest of your body. Seeing that my body and my general fitness are not at their best during this period of my life, I figured this would not be the best solution in the long term.

My sports physician however, was not desperate at all. He was very satisfied with the results we were at right now, and assured me that I was still on my way to making a complete recovery. It was a matter of time, patience and carrying on: keep doing my stretches, keep going to my physical therapist, keep walking-but-not-too-much, and especially steering clear of operations and injection. He suggested that I could see my podiatrist and ask her if it was possible to tweak my fancy insoles to aid my recovery. This turned out to be the case. So with a compression sock on my injured leg, tweaked insoles and with my foldable cane in my hand bag I kept my hopes up and my walk on. In moderation, of course.

In the following months, I noticed that the pain very slowly but very surely decreased. After a while, the pain shifted to a different spot in my calf, probably due to the insole adjustment, and eventually the Easter egg on my achilles tendon shrunk back to pea size. I monitored my pain levels every day, and while I would sometimes suddenly have a very bad day, in general the days in which I was in pain decreased. At the beginning of 2020 I realised that I had been pain free for a whole week. A little while later I saw that the bump on my tendon was gone.

At this moment, more that two years after this injury started, I seem to have completely recovered. I am slowly building up both the amount and the intensity of my walks, and I do notice that my leg is less strong, for lack of a better term, and that my muscles tense up quicker. The fact that I am no longer 20 most likely also factors into this. Fact is, that I will have to be (more) careful than I used to. My most important goal at the moment is therefore to make sure I don’t get injured again, both specifically not reinjuring my achilles tendon, and in general. Which is a case of just carefully putting one foot in front of the other, I guess.