Insertional Achilles Tendonitis and Bone Spurs

When I was 8 years old and I was "skating" in my neighbor's yard across the street. Her father put in a wooden frame and filled it with water to freeze. It made a great ice rink for us "city" kids. I had never skated before and I had no idea how to skate. I was never an athlete and balance was not bestowed upon me at birth. So naturally I broke my leg as I crashed into the side of the house. I never learned to skate even though I attempted it a few times later in life. Knees ripped out of jeans, bruised hands, and the wind knocked out of me stopped me from trying ever again. 

The cast placed on my leg was too tight and went ignored by my care givers for weeks even though I complained about it repeatedly. Finally after 6 weeks when I went from the long cast to the short cast did the nurse listen. I did not get the cast removed but shortened with a cast saw from upper thigh to below the knee. They also added a little cut out window on the heel to appease me. When they cut the heel opening they noticed that my heel was raw and had bled at one point or many points. Still the cast remained and I had a damaged heel.

Running shoes, walking shoes, dress shoes, any shoe with a heel hurt my foot. My heel would actually rub the fabric off the shoe causing more irritation to my heel.

Hiking was always a love hate adventure. I loved the down but hated the up...yeah not because the up was more work but because of the pressure on my heel.

Mike and I did a 7 day climb of Kilimanjaro and I was well prepared for the trip. I broke in my boots, had extra heel padded socks, and had mole skin pads to protect my heel. The first day I thought I was golden and felt no pain. Then I took off my boot, my sock, and then layers of mole skin to find that I had rubbed off a few layers of skin. Ugh Mike helped cut away the layers and we put ointment on it and wrapped it. I was smart enough to bring crocs for none hiking evening.

 

One of the fellow travelers was an EMT and he said he would wrap it for me the next day. He graciously got up an hour earlier than needed to assist. Again I was optimistic about the day's hike. The hike ended around 6 pm and it was time to check the heel. Again the wrapping did not prevent the heel from being damaged. 

After the 7th day of hiking you could practically see the bone in my heel. There was no skin left and it bled constantly. Everyone knew of my saga as Mike and I were up at the crack of dawn trying to prepare my foot for the day, but not because I complained about the pain.

When we got back to the hotel we slept, showered we went down to meet everyone for breakfast. I was in flip flops with no bandage and everyone was grossed out about the site of my heel and was amazed I had actually finished the 7 day hike and I must have been in so much pain. I have a HIGH threshold for pain.

Skipping ahead a few years I was doing boot camp in Saudi Arabia and did a lunge that caused so much pain I collapsed. I believe I damaged my Achilles. I could not put my foot flat for months. I walked on tip toes when I had to and stayed off of it the rest of the time. years later it felt better and I forgot about the pain.

Then again I was doing aerobics and did a lunge of the step and felt the same pain. Again I did not go to the doctor and reverted to walking on my tip toes.

Did all these events contribute to by diagnosis of  Insertional Achilles Tendonitis and Bone Spurs or just one event? I will never know. After a year of pain I decide to have it looked at and the xRays showed 3 bone spurs.

And just encase you cannot tell where they are:

   

The orthopedic was surprised that I was not taking any pain meds and that I was just dealing with it. She recommended a topical cream, similar to Voltaren Gel, and PT with dry needling.

The pain feels like my bone is going to rip through the skin at any moment. It is a constant fiery pain that does not allow me to place my heel on any surface even while sleeping. If I lay on my back I am immediately woken from the pain. I decided to try the topical cream and the PT with dry needling.

"Achilles tendinitis is a common condition that occurs when the large tendon that runs down the back of the lower leg becomes irritated and inflamed. The Achilles tendon is the largest tendon in the body. It connects the calf muscles to the heel bone and is used when you walk, run, climb stairs, jump, and stand on your tip toes. Although the Achilles tendon can withstand great stresses from running and jumping, it is also prone to tendinitis, a condition associated with overuse." (https://tinyurl.com/mr6syzax)

So basically my Achilles tendon has shortened due to the damage and me walking on my tip toes. So I need to stretch out the Achilles to avoid surgery. 

"Dry Needling is a procedure done to promote the healing process in an area of tendinosis or chronic tendon injury. The procedure stimulates blood flow to the area which brings with it growth factors that trigger stem cell recruitment, stimulation of fibroblasts, and induction of the healing cascade." (https://tinyurl.com/25t6z529)

This is me being dry needled. She would normally stick more needles in but I was winding down on PT before I thought to have her take pictures. Most of my stress and tightness is at the ball of my calf and the pain is at the side of the heel.

 

This is a quick video of the stim that is added to the needles. I mentioned I had a high threshold for pain and every physical therapist commented about how high I had the voltage. 

 

After weeks of PT, dry needling, pecking (stabbing the bone with a needle) and my own exercise routine I am 90% pain free doing regular activities. Walking up hills and stairs still cause me pain but not to the extend it once did. Many, many thanks to my physical therapist, Kat!