Achilles tendinopathy and plantar fasciitis Achilles tendinopathy and plantar fasciitis

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Thread: Achilles tendinopathy and plantar fasciitis

  1. #1
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    Default Achilles tendinopathy and plantar fasciitis

    Sorry for the lengthy post, just delete if it's too long and I'll cut it down. I initially posted this in the Recovery forum where some guy trolled it, and Simma recommended I try the Q&A instead. Here goes:

    - Background: Age 34, male, 6'1", 200lbs, currently on LP after layoff, trained with barbells for three years total including one year layoff. General trainee, not competitive or active in sports.

    - Chief complaint: Heel, achilles tendon on my right leg aches and hurts up to the soleus muscle calf muscle. Some aching in the outside of the sole of the foot as well, the abductor digiti minimi if I'm not mistaken. Lingering case of plantar fasciitis that started two years ago. Deadlifting aggrevates it a lot, squatting aggrevates it to a smaller extent.

    - Injury: I'm just going to describe this in chronological order, because it's really a series of events that lead to the current injury. A couple of months ago I got a minor injury in my left vastus lateralis that I rehabed with massage and foam rolling. Deadlifts made it worse so I avoided deadlifting for about a month until the injury was gone. I then did a set of deadlifts at 265 lbs six weeks ago (45 lbs below work set weight), and the following day my right calf and achilles were really tight and achy, a bit swollen and warm. I have had a case of lingering plantar fasciitis for a couple of years, figured it was acting up again. At the time I didn't think too much about it, and chalked it up to one of those things that happen when you lift weights. Stupid, I know. Started stretching my calves before and after training sessions.

    Now for the weird part. I'm not sure if this is really relevant, but I'll include it anyway because this is the way it happened, though I suspect it's a post hoc ergo propter hoc situation. Take it for what's it worth. One day I woke up coughing and sick with fever, went to the doc, confirmed inflammation by CRP blood test, diagnosed with bronchitis after stethoscopy. I got a prescription for antibiotics (Apocillin). Went home, did nothing but lay on the couch all day. Foot didn't bother me too much at that time, though the calf was tight. In the evening I took a double dose of antibiotics and went to bed. The following morning I wake up and immediately notice the foot hurts real bad. The calf and achilles are super tight, and the surrounding area is swollen and warm and borderline cramping all the time. What the hell? I don't know if the nocebo effect was happening, but every time I took antibiotics the foot would start cramping up after about 30-60 minutes. I ditched the antibiotics after a day, fever went down in a couple of days.

    After that I trained normally, leaving out deadlifts. The foot gradually got better, though squatting aggrevated it somewhat. Two weeks ago the foot was better, so I did a set of 220 lbs deadlifts, and the following day the foot was tight, swollen, warm and aching again. I realized this shit isn't going away and I better figure it out and start rehabing before it gets worse. I booked an appointment with a physical therapist with specialization in sports injuries. He palpated the achilles and heel and confirmed there was problems at the insertion of the plantar fascia and achilles tendon. He recommended a regimen of 2 sets of 15-20 reps of eccentric calf raises with knee in extension and in flexion, twice a day for six weeks. No deadlifting. He asked me to consider stop deadlifting altogether.

    - Pain: Initially 7, now 2 at all times, 3/4 the morning after squatting. Pain is aching. Deadlifting makes it worse for sure, squatting also aggrevates it. At its worst standing presses also aggrevates it. Walking around is uncomfortable, but not really painful at this time. I suspect the aching in the abductor digitt minimi is due to trying to relieve the heel when walking, by stepping more on the outside of the foot. Rest seems to make it better, ibuprofen gives good relief. Ice packs help with swelling and aching. Pain is worst first thing in the morning, especially after squat sessions, the foot is stiff/rigid. It loosens up once I start walking around.

    - Signs and symptoms: The area around the achilles tendon is somewhat swollen and warm. More so the day after squatting. Aching pain at the back of the heel as well as the bottom of the heel (plantar fascia), to a lesser extent the abductor digiti minimi.

    The way I see it this may be two separate problems - the plantar fasciitis and this new achilles tendon thing. I'm considering getting an X-ray done, if nothing than to rule out a calcaneal spur due to the lingering plantar fasciitis. Treatment regimens for achilles tendonitis I've found online recommends the following, though the use of NSAIDs is somewhat disputed:

    Nonsurgical Treatment:
    Rest
    Ice
    Non-steroidal anti-inflammatory medication
    Calf stretch
    Eccentric Strengthening Protocol
    Bilateral heel drop
    Single leg heel drop

    I've seen foam rolling the calves recommended for achilles tendonitis, though I'm not sure about this. Previously I've used a lacrosse ball under the sole of my foot for the plantar fasciitis, with some success. I know I've fucked up on this one, should have started rehab sooner and gotten rid of the plantar fasciitis way sooner. I'm breaking into PR territory on the squat, but I wouldn't want to continue the linear progression at the cost of aggrevating the injury further. Any recommendations on how to proceed to fix this is much appreciated.

  2. #2
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    There are some aspects of this presentation that might indicate a DVT. I'd have this checked ASAP.

  3. #3
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    Rip is on point. Get an altrasound. Much of what you described is how my DVT presented in my calf. Get it done now to rule out that which can kill you. I walked around like that for a month.

  4. #4
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    Fucking hell. I'll get right on it.

  5. #5
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    Belated update: It turns out Rip was spot-on. Ultrasound showed that I have a blood clot consistent with DVT just below the back of the right knee. I'm on blood thinners now, and will be for 3 months.

    They say that which doesn't kill you only makes you stronger, so I look forward to setting some new PR's soon. All in due time, this gave me a good scare.

    Rip: I really don't know what to say. Except thank you. Thank you, thank you, thank you.

  6. #6
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    Rip for the win. As I read the OP's first post the only thing i could think was DVT. I had the exact same thing several years ago. Genetic clotting disorder. I ignored the symptoms for a month.

  7. #7
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    Saving lives over the Internets - goddamn!

    All in a day's work, eh, Rip? Certainly earned a shot of the good stuff, tonight...

  8. #8
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    Quote Originally Posted by tallison View Post
    Saving lives over the Internets - goddamn!

    All in a day's work, eh, Rip? Certainly earned a shot of the good stuff, tonight...
    (Just to be clear: zero snark intended there -- only very well-deserved admiration.)

  9. #9
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    Thanks, tallison.

  10. #10
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    Quote Originally Posted by Beau Bryant View Post
    Rip for the win. As I read the OP's first post the only thing i could think was DVT. I had the exact same thing several years ago. Genetic clotting disorder. I ignored the symptoms for a month.
    I can't believe I walked around with this thing for over two months. This stuff happens to 60-year olds, right? Not at age 34. Or at least that's what I used to think. Fucking hell.

    As far as what caused the DVT to happen in the first place the docs are not sure, but genetics most likely plays a part. Here's to hoping it won't happen again soon.

    I would like to thank Beau for chiming in with his experience, and Simma for being helpful and directing me to Mark's Q&A. I'm eternally grateful for your advice, Rip. Shit got serious real fast. I sound like a bitch, I know, but it is truly in earnest. You can handle it, so thank you once again. By the way, my girlfriend of the last 11 years totally loves you now. Hah! (sorry stef)

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