I am currently doing the heel drops on a flat surface, it seems to help, I am only on my third week. I still have the problem, but will persevere. I did the drops off a step one day, and was in more pain the following morning so have gone back to the other one.

I know this discussion is pretty old, but I figured I would chime in with my experience. I’m no athlete. I’m a 31 year old woman who works at a hospital and stands or walks for most of the the work day. One evening about two weeks ago I was getting my things together before leaving work. I took a step and felt/heard a loud pop. You can guess what happened; I ruptured my Achilles’ tendon.

My ortho was puzzled about how this happened, since I was not engaged in any strenuous physical activity. Even an MRI yielded few answers, though it did show Haglund’s deformity (and, also, he could tell that just from looking at my heel). During surgery to repair this mess of an injury, it all became clear. The Haglund’s contributed to bursitis and insertional tendinitis. My Achilles, in fact, had become so degenerated that 40% of it had separated from my calcaneus entirely. The remaining 60% was not strong enough to hold, so it ruptured higher up. He he had to do a complicated re attachment and repair, which involved shaving down the Haglund’s, screwing the tendon back into the calcaneus, repairing higher up, etc.

In short, I will *never* wear a shoe again that is not Achilles supportive. I was wearing a lot of Sanuks, Tom’s, flat Merrill’s, etc. This ordeal has been a nightmare, and I’m very invested in protecting my Achilles at all costs! I’m wearing one ASICs Kayano right now. Can’t wait to put the other one on when this ortho boot comes off in 12 weeks.

Allan- very curious on how your surgery and ultimate recovery went? Were you able to return to your normal running? Any problems? I have been suffering through all the same problems for over 15 years. My last conservative approach before surgery.
Can anyone else tell me about their experience with surgery for these problems.

Is there any difference in pain level when walking down stairs barefoot vs. in your typical shoes? Also, what shoes do you wear? Sometimes a shoe with a hard backing behind the heel can exacerbate pain at the Achilles insertion.

Cool, thanks for the link. I’ll try the flat eccentric heel drops. Basically it’s just like a heel drop, except you do it on the flat floor instead of a step?

Hello!  I’ve enjoyed
reading your blog for some time, and as a “new” blogger myself, have used it as
a learning tool.  That said, Allan’s
story is a familiar one.  I am a
Certified Athletic Trainer, and I’ve treated athletes of all levels, from
recreational to Olympic level, for the past ten years.  I should also toss out the disclaimer that it’s
difficult to make general recommendations, as every athlete has a unique
biomechanical structure, and it’s been my experience as a clinician that unless
I am in the same room with said athlete, my thoughts are generalizations rather
than specific, so may vary unless my physical findings tell me differently.  In a perfect world, I would love to see his
gait, walking and running, and evaluate a number of items, including his foot
type, both standing and sitting. 

That said, it makes PERFECT sense that high heeled shoes
would eliminate his pain, as it positions the foot in a plantar flexed state,
thereby taking substantial pressure off of the Achilles tendon and more
importantly, creating what is known as an open packed position which creates
more space within which soft tissue can “move” without further impedance.  When I teach this concept in courses, I use a
slinky as a teaching implement.  A
compact (closed packed) slinky is a small, rigid area.  You can only fit so much in it’s finite
space; however when the slinky is stretched (open packed), you can fit
substantially more in it’s more infinite space. 
 Another way of thinking of this
is that when the foot is fully dorsiflexed, it is in a closed pack position
(stretching the posterior musculature and further annoying the tissue). Simply
changing the foot and ankle in a different position of a few degrees can
dramatically change how that tissue interacts with it’s structural “neighbors”,
if you will.

Working up the kinetic chain, I’m curious how the
musculature surrounding his hip is; that is, deep tissue work on the gluts
(specifically the glut med) may free up some motion, creating more freedom of
movement below.  He states he had a hip
injury with lots of down time; in his case I would go right to the SI joint and
assess both pelvic structure and soft tissue surrounding it.  It’s very possible further work here is
needed, and may possibly be limiting his overall management of the Achilles/et
al. issue.  Of course, the only real
problem left is the Haglund’s deformity, which presents substantially and other
than surgery, will be omnipresent.   I
agree with his self assessment of continuing to wear traditional running shoes;
this can only help, not hurt.  As we are
learning with stretching, it’s not good to always “stretch” tight or sore
structures; in fact, when done to excess, it impedes healing.  It’s also possible he may need a longer
period of rest (I know, I know, it stinks, but is sometimes quite necessary)
and more aggressive therapy well above the injury site.

As for retrocalcaneal bursitis or “pump bump” as it’s
commonly called; you do want to limit the friction caused by shoes.  That is, it may not hurt while you are in the
shoe, but if it rubs too much, over time it will lead to the area becoming
agitated.  It does present a bit of a
conflict: wear loose shoes while running! 
I know, this flies in the face of what you are looking to do, but some
ways to subtly change this are to lace your running shoes in reverse; tie them
down near the toes and keep them a bit looser near the eyelits close to the
ankle.  This may help. Or, wear your
shoes looser during the day when you are not running, thereby limiting the
amount of time your heel is in direct contact with the counter.  If you are at a desk job, straighten your knee
a bit, and allow the foot to rest in a more open packed state (plantarflexed,
toes pointed down).  Doing this a few
hours each day may help balance out the time you spend dorsiflexed (standing,
walking, running).  Orthotics may help,
but it’s been my experience that most of the time, they don’t.  You might be able to try a heel lift in the less
structured shoe.

So, just my initial thoughts as he tries to keep surgery as
a last option. At any rate, hope this helps a bit; and if anyone would like,
you can check out my blog http://www.essentialatc.blogspot.com   

I currently run in Newton Gravitas Trainers. I’ve been running in them for almost a year now, but haven’t experienced these symptoms until the last month. I also wear custom orthotics, so they add some to the heel/toe drop of the Newtons. I don’t know exactly, but they are certainly a few mm above the normal 4.

I have a million cause/correlation scenarios, and really no way to determine what will help beyond crude trial and error. Too much mileage on my Newtons? Do I need new shoes? Different model? New orthotics? No orthotics? Additional heel lift? More rest? Stretch/no stretch? Very frustrating. This and I have come off of a year long ordeal with ITBS has almost got me to quit running altogether.

I have the Kinvara and some lighter racers/trainers. That is the route I’m going with for now although it is frustrating. I really liked running barefoot…

Hi Kevin

I am a 41 year old sprinter suffering from achilles bursitis, and found your post very useful.
The only thing that was unclear (I may have missed it) was whether your patients are actually running in their modified shoes (with heel counters cut out)?

I have had the condition for four weeks, and iced and used ibuprofen gel regularly for the first two. The inflammation and pain has reduced dramatically, but I can still feel it first thing in the morning when I get up. I have not trained at all as I have had tonsillitis and a chest infection at the same time. I did do calf stretches for a week or so, but then wondered if they were aggravating the bursa.

I have not been wearing heel lifts, but am going to give it a try. My question is, are you advocating that your running patients return to training using the modified shoes BEFORE the condition has cleared up 100%?

My gut feeling is that if I can still feel the condition (albeit only slightly) when walking, won’t a return to jogging or sprint training just re-aggravate the injury, even using heel lifts? And won’t that slow down the overall recovery?

I’ve been using minimalist shoes for more than a year and had adjusted to having no heel differential, but was doing calf stretches for several months before the injury to overcome tightness and improve dorsiflexion and ankle mobility.

Is active recovery the way to go, or should I wait until I am symptom free?

Thanks in advance for your advice.