Daily Mobility Exercises by Dr. Kelly Starrett › Forums › Foot/Ankle › Achilles Issues and PT

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    • 03/30/2018 at 9:50 pm #71874
      AvatarMary Dulaney
      Participant

      Hello all, I have been dealing with achilles issues since about September of last year where it got much worse as of January of this year. I have been visiting a PT and have two more sessions left. The problem is severe pain at the attachment of the achilles to the calcaneus — serious pain, tender to the touch, inability “toe-off” when walking.

      The PT recommended Superfeet insoles since I have skinny ankles, high arches, and rather large calves, which is causing strain on such a small achilles tendon. 
      I have also noticed that at times my lateral maleolus feels tacked down and my PT has said that there is some scar tissue distal to the LM and that the insoles could help, too. I know Kelly advocates little to no padding, and zero drop shoes, which I try to stick with as much as I can, but do you all think it would be a good idea to use them at least for a while until my achilles gets better?

      My doc also mentioned that I could be having bursitis down there, but neither he nor my PT has mentioned anything about fixing that.

      As of yesterday, I have aggravated the AT, testing to see if it was feeling better by doing a light jog and some skipping. The skipping really did me in, so I decided to turn to the community on this.

      tl;dr: to superfeet or not superfeet because of high arch/skinny ankle/huge calf achilles tendon issues? Possible bursitis in the area? Sticky lateral maleolus? What to do?

      Thank you!
    • 04/02/2018 at 10:09 pm #77169
      AvatarPatrick Thomas
      Participant

      Did the achillies issue originate from running?
      Running with tight calf muscles places more stress on the achillies tendon.

      Are you looking at movement patterns?
      Working up &downstream?

      What changed/ happened in January to fire things up?
      Are you seeing improvements with what you are doing during PT?

      Bursitis occurs when a bursa is irritated from frequent pressure and it becomes inflamed. May be time for a new pair of shoes during the day or while training.

      Lateral malleolus is a stabilizing factor of the ankle joint.
      Couple to start with:
      Episode 167: Unglue That Heel Cord
      Achillies Tendon Problems (3rd video in the series)
      Monday, May 29th, 2017 – Achilles Tendon

    • 04/04/2018 at 4:20 am #77171
      AvatarMary Dulaney
      Participant

      The achilles issue did not originate from running,  I’m not exactly sure how it happened, but it would flare up during my normal strength and conditioning (Power Athlete, Grindstone) programming.

      Yes to working upstream and downstream, plantar fascia voodoo smashing, bone saw, and anterior tibialis smashing. I just can’t seem to ball whack properly to feel like I’m getting a good response from it.
      The achilles kept getting aggravated for a few days each month starting in September, where January I experienced the most pain and it took much longer to “heal” the tissue. As far as training goes, nothing had changed.
      I’m seeing improvements with ROM especially in my right ankle but nothing with respect to alleviating pain or attacking the soft tissues itself. Left ankle ROM is not good at all and the PT exercises hasn’t done much to improve it.
      I’ve replaced my work shoes and boots, might be high time to replace my workout shoes which are metcon 2’s that I’ve had for probably a year? The soles don’t show much wear, so I haven’t considered replacing them. Follow up: should I go with insoles per the PT, or just work on more mobility, maybe do some intensive work on my calves? FYI, these big calves definitely do not like pressure applied to them, which is a good indicator that they need some lovin’.
    • 04/16/2018 at 3:12 am #77173
      AvatarPatrick Thomas
      Participant

      Is there a particular movement(s) or position(s) within the programming which is causing the flare ups?
      A new or different movement during the times of the flare ups?
      Or an increased number of reps of a movement?
      Is your arch collapsing?
      What is going on to cause the achillies issues?
      The cause may be outside of your training time– environmental loads.
      Changes in other parts of the day?
      Changes in work shoes from the prior pair?
      Are you warming up/cooling down with workouts.
      Nutrition — decrease in eating connective tissue within diet? This happens with eating leaner meats or not on the bone. The connective tissue has key amino acids which are large components of the collagen& collagen matrix that make up the health of a tendon.
      Have you been taking antibiotics?

      Good to hear you are working up/down stream of where you see the issue.
      Have you addressed the ankle and/or hip joint capsule?
      Pro Episode # 21 – Pro-User Request Friday: Not Seeing The Change? You Need a Systems Approach.

      Can you have someone ball whack the area for you?
      Tuesday, October 31st, 2017 – Ball Whacking & Gua Sha

      Good to hear you are seeing ROM improvements with your right ankle.

      Gastrocnemius and Soleus are the main sources of power for the motion of the ankle. When the calf is tight the ankle is not able to move properly. The connective tissue of these muscles form the achillies tendon at the back of the ankle. They are interconnected when one is tight the other is tight. With sore or tight muscles our movement is different. Concentric motion (going from standing to tip toe) is impacted.

      The soles of your workout shoes may not show much, however, the inside are worn out if they are a year old.

      Sounds like your calves are asking for attention.
      What are you doing to desensitize the painful area?
      A Leopard Claw or HawkGrips work great or if you have another tool is one way to desensitize the area.
      This will help to feel less distress and shock in the tender area(s). Gradually exposing this area to more aggressive work is more effective. You want a dose and a response.

      In the beginning, 2 shorter (5:00 or so) sessions may be needed. Manageable doses is key to being consistent with working on tender areas. Daily doses start to normalize the tissue.

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