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Old 02-06-12, 06:52 AM   #1
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A puzzling ankle pain. (warning somewhat long)

All,
I have had an ongoing pain and swelling in my left ankle on the Achilies (sp) tendon for 4+ weeks now. It seems worse mid afternoon and evening but was really hurting early Sunday morning. I haven't twisted it or stepped off wrong that I can ever recall, it has been broken once in 1979, but healed completely, cleared by a Navy Flight Surgeon.

The tendon is somewhat swollen and is tender to the touch, feels a little hot at times, also. Here is the strange thing, walking it gets worse and that triggers the shin splints in my left leg I am prone to because I have to change my gait to compensate for the pain (as in going for a 1-2 mile walk with my wife) but I can bicycle completely pain free now.

Early on it did hurt to push hard and I gave myself some time off the bicycle. Now I spin more than mash and the pain in the tendon isn't a factor at all. After a ride it seems to slowly come back to the painful condition. Is this worth a doctor's visit, I have a very good podiatrist team I see when needed, are they the best place to go? Thanks for any advice y'all might have, and please tell me how to spell the name of the tendon before I go crazy, no dictionary at work.

Bill
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Old 02-06-12, 07:08 AM   #2
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The more I read about tendinitis the less I understand.(Had a bout with it in my knees last fall.) Not long ago Delayed Onset Muscle Soreness was blamed on Lactic Acid buildup. Now it's like don't worry about it blaw blaw blaw. I think most doctors view pain as an opportunity.
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Old 02-06-12, 07:20 AM   #3
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After 16 major surgeries since 2000 I am not an opportunity any more I agree with you and have been refusing more surgeries simply because I am tired of laying in hospital beds and having PICC lines in my arm/chest. I think I need less pills and more saddle time now. I do suspect that the podiatrist may be my best bet if this keeps up for a bit more.

Bill
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Old 02-06-12, 09:07 AM   #4
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Achilles? That form of tendonitis is common and vexing. You might need to stop cycling for awhile to recover. That tendon is prone to inflammation and even rupture for us aging weekend warriors.

My bias, based on no profound insights: avoid surgery. Avoid injections (ouch). NSAIDs help. Opioids help you forget how much it hurts. When we get old, rest is best. A good physical therapist might help, as no injury exists in a vacuum: if you walk funny because of ankle pain, then you knee, hip, and lower back will also hurt right up the line. You might need LESS saddle time, sad to say.

I knackered up my neck and right shoulder by, of all things, playing the cello. I masked the pain with analgesics. That was stupid. Now I've had to give up the instrument for the foreseable future. Warning to the wise.
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Old 02-06-12, 11:39 AM   #5
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Of course you should see a doctor... But, I was wondering have you tried an ankle brace while riding?
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Old 02-06-12, 12:58 PM   #6
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I would go to a podiatrist. I had a problem with my planar tendon and needed orthotics, soft taping and a shot of cortisone to fix the problem. Tendon injuries take a long time to heal. I try to find solutions recommended by and under the guidance of a conservative doc that allows me to do what I want to do.
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Old 02-06-12, 02:32 PM   #7
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I think that the podiatrist is my best shot, too, he fixed the same ankle when I was a well engineer and stepped into an open grating on the drilling deck. How did you knacker your knee with the cello Dudelsack? I know the position you must use but I never figured that for potentially harmful.

I have pain killers for long term chronic severe pain and I keep it very low in strength (permanently open surgical wound on my belly) with the Pain MD's backing so I will not be buzzed. It is a synthetic opioid so it would be super easy to go nuts and get addicted and loving the crap. Very picky about this and I ain't having more surgery after 16 major back and abdominal in 10 years. The riding was too long gone for me. If the Podiatrist or physician say to lay off I will but I'll find a sports doctor to rehab me. We have a major national sports medicine clinic here (Andrews Sports Medicine.)

Thanks for taking time to offer advice. Hope you can play again Dudelsack, I am a cello work lover and would hate to give up all that time you invested in learning to play. Classical music is a passion for me.

Bill
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Old 02-06-12, 08:40 PM   #8
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I had almost the same pain. It turn out to be gout.
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Old 02-06-12, 09:20 PM   #9
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the Achilles is not something to mess around with. if all that inflamation results in a tear you'll be off it for 6 months after surgery. chronic pain and swelling in a tendon as major as the Achilles is a very dangerous situation, see an orthopedic doctor. could be related to many causes, tight ITBs, tight hamstrings, etc. also, consider getting checked out by a sports massage therapist to see if your ITBs or hamstrings need to be released. meanwhile, no walks (make her ride) and plenty of ice. good luck and let us know.
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Old 02-07-12, 03:59 AM   #10
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+1 for gout.
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Old 02-07-12, 06:54 AM   #11
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Didn't initially think about gout but that is definitely worth checking. I got a recommendation for knee surgery (Patella tendon showed scaring on MRI) but when the other knee flared up I got a second opinion. It was gout on both sides. It usually gets the big toe first but it can hit elsewhere.
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Old 02-07-12, 07:05 AM   #12
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I'll ask about gout but the pain location and the constant pain, not in attacks, like gout usually hits you, make me doubt that. Not ruling anything out at this time. The swelling is on the tendon itself and not in the ankle joint, or the bursa sack, where the uric acid crystals would form and aggravate the tissue.

Not enough beef or other high protein food in my diet either. The back of the tendon is the only area in pain and is sensitive to the touch and when I bicycle, especially spinning it does not hurt at all. I actually am pain free when I ride and afterwards. Stretching seems to help the most. I do stretches before and after my rides.

IT band is a real possibility with my history from running so much in HS and college and when I taught school.

I see the Pain Management doctor Thursday for my check up and I'll ask him to call my family medicine guy so I can get a referral to a specialist. Hopefully at Andrews Institute Sports Medicine in Gulf Breeze. My wife and the walks are not an issue she and our son both ride with me and will ride before walking. The walk Sunday was a one off to exercise when the thunderstorm threat kept me from riding.

Thanks so much for all of your input and information. it is all being absorbed and added to my list of questions for the doctors.

Bill
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Old 02-08-12, 06:01 AM   #13
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I too am dealing with achilles peritendinitis (self diagnosis at this juncture) and waiting to see a sports/ortho dude next monday. I've been off the bike all together for 1 1/2 weeks and it is driving me crazy, but I want to get this sorted out and rehabed properly, lest I cause a chronic condition.
Just a FWIW, a couple other associated conditions with achilles tendinitis are familial hypercholesterolemia and rheumatic conditions- both of which both or either of my parents had/have.
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Old 02-08-12, 06:10 AM   #14
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Noclutch
Sorry you are having problems, too. I hope the ortho guy can help you out. My Pain Management doctor's appointment is tomorrow and I'll ask him to call my physician for a referral (ain't health insurance regulations wonderful?) I can understand how the rheumatic condition would cause problems in the joint but that hypercholesterolemia could cause joint/ligament problems is a stumper to me. Could you enlighten me a bit on this condition if you don't mind?

Best of luck in your diagnosis and recovery. At least Bicycling relieves my symptoms I'd go crazier if I was kicked back again. Hoe the spinning motion relieves the tightness and pain puzzles me but I will enjoy the therapy while I can.

Bill
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Old 02-08-12, 11:18 AM   #15
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Bill- apparently xanthomas are fatty deposits can be in many locations, including tendons, in hypercholesterolemic people. There are several articles about this out there but I don't know what the prevalence or relevance is... See this one if you're up to a dry read.
The way I read it, fatty deposits within what shold be more solid connective tissue(tendon) can't be a good thing, and if the deposits are on the surface of the tendon( as palpable nodules) that can't be good for the interaction between it and the paratendon(sheath). But take any of this as FWIW...
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Old 02-08-12, 12:45 PM   #16
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Certified Athletic Trainer? That's also a good place, at least to start.
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Old 02-09-12, 07:55 AM   #17
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Thanks for the explanation noclutch, you helped me understand that item better. Billydonn, that is a very real possibility since Andrews Institute of Sports Medicine is located in Gulf Breeze and they take the general public for problems as well as elite athletes. I'll be asking for some referrals today and next week. Still, I am able to ride painlessly and I maintain that the spinning motion helps relax the tendon. The pain hits worst in the early afternoon before I ride or can stretch and when I get out of bed in the early A.M. This is why I called the condition Puzzling I suppose.

Bill
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Old 02-11-12, 04:26 AM   #18
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I am not going to be much good for this conversation. I've had almost identical symptoms to you, qcpmsame, and despite current fit wisdom (including my own), I traced it back to having the saddles on several bikes too low. There was no frontal knee pain associated with this. I also was returning after an extended period off the bike in 2009, and may have been pushing too hard under load. In addition, my work required all sorts of odd foot positions.

I was in great pain, just walking usually in the mornings. I lived through it. The tendons have swelling on them.

Now, I can walk pain-free. I seemed to be able to ride pain-free right the way through the experience.

The cruncher is: I had no medical consultations on this. I rested when I could (but time off work was limited because I work on a casual basis). I took several pain medications (nothing stronger than off-the-shelf stuff such as acetominophen and paracetamol with codeine occasionally. And the key thing was I readjusted my saddle height upward. I used ice once or twice. I didn't use any strapping. I did very gentle stretching, usually while taking a hot shower, and avoided pushing beyond the pain. I also got some work boots that fitted better than my originals, particularly so the backs didn't press into the tendons.

It took about six months for the pain to subside entirely. That was about a year ago, and while I have had the occasional twinge. my Achilles tendons have been fine with around 6000 miles of riding in the period since, including some very tough climbs in the 7 Peaks Alpine Challenge.

I am not one to dash off to the doctor, even though we have a very good public health system here in Australia. Heck, after I had a anterior dislocation of a shoulder after I fell from my bike in 2004, I think, I went to one follow-up appointment with the specialist who said: "Good, keep up the exercises the physio gave you". I didn't want to complicate things by saying I hadn't been to any physio, and the only exercise was through the handlebars of my bikes.

I don't know what you can take out of this. Maybe check the fit of your bikes concerning saddle height. If it is obvious that there is no tearing, and gout is not considered an issue, and recognising your pain management, then resting when the pain is worst, spinning while on the bike, and a bit of massage with ice and heat alternately might be useful.
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Old 02-12-12, 08:32 PM   #19
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Funny you should say this Rowan. I raised the seat a bit and noticed a better feel to the pedal stroke last time. the ankle had been pretty quiet this weekend but I am still seeing my regular doctor this week to let him examine it and give me a referral. I am calling Andrews Clinic in Gulf Breeze too. Maybe the saddle was the answer. Thanks for the input, nice reply and information.

Bill
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Old 02-16-12, 11:37 AM   #20
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Bill- how is yours comming along? MD explain things well for you? Hopefully yes on both

I got into an ortho doc this week. He didn't have much to add beyond what I'd surfed up and felt that I could start back cycling easily and see where it goes. He is a strong proponent of eccentric exercises, too. So yesterday I had my first easy little/85% speed 70 minute/13 mile ride in the flat singe track yesterday and all seems good so far. No sypmtoms before, during or afterwards, though I did ice it just for grins.

Regarding saddle height and achilles, I've seen/heard two perspectives. One is too high a saddle forces one to be too toe down much of the cycle, not engaging the calf enough, resulting in a loose/untensioned achilles that then "whips" taught cyclically when dosoflexion happens at the top of the stroke, and that is the abnormal stressor leading to microtears. I for one can attest that when mine was hurting, a hyper toes down posture actually lessened the discomfort as I was ankling less that way, thus keeping the achilles/peritendon more imobilized every pedal cycle, FWIW, but it was very un-natural pedaling technique. Conversely and more obviously, too low a saddle will force one into too low a heal pedaling posture, resulting in too much stress on the tendon, especailly if the ankle is already at max dorsoflexion and a hard push is done such as over a root or ledge. My take away is proper saddle height might be key in keeping this problem at bay. Oh and I did scoot my cleats far back and that too takes much of the load off of the tendon, but still feels kinda awkward still, but I've only done one ride that way so far. It is gonna be hard not to hammer the hills for a while still- arrrgh!
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Old 02-16-12, 01:48 PM   #21
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Originally Posted by qcpmsame View Post
All,
I have had an ongoing pain and swelling in my left ankle on the Achilies (sp) tendon for 4+ weeks now. It seems worse mid afternoon and evening but was really hurting early Sunday morning. I haven't twisted it or stepped off wrong that I can ever recall, it has been broken once in 1979, but healed completely, cleared by a Navy Flight Surgeon.

The tendon is somewhat swollen and is tender to the touch, feels a little hot at times, also. Here is the strange thing, walking it gets worse and that triggers the shin splints in my left leg I am prone to because I have to change my gait to compensate for the pain (as in going for a 1-2 mile walk with my wife) but I can bicycle completely pain free now.

Early on it did hurt to push hard and I gave myself some time off the bicycle. Now I spin more than mash and the pain in the tendon isn't a factor at all. After a ride it seems to slowly come back to the painful condition. Is this worth a doctor's visit, I have a very good podiatrist team I see when needed, are they the best place to go? Thanks for any advice y'all might have, and please tell me how to spell the name of the tendon before I go crazy, no dictionary at work.

Bill
After 4+ weeks of pain I would expect a post here to get advice from a young inexperienced person but not one of your age. The fact that you have not been to see a doctor already is very disappointing in more ways than one.

MAN UP AND GET YOUR ASS TO A DOCTOR BEFORE YOU REALLY SCREW SOMETHING UP IF YOU HAVEN'T ALREADY. SHEES!
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Old 02-17-12, 07:25 AM   #22
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Seems to be a simple strain of the ligament relatively close to the attachment at the calf muscle and is easing up. Doctor examined it and said to rest it when I can and call the Family Medicine guy if it last for more than 2 weeks. Pain is lessening with some careful stretching and spinning rather than mashing gears while I ride. it has always felt much better after a ride and I stretch before and after. If it keeps lightening up I'll just watch it and call the Fm guy next week as a precaution. Andrews Institute still sounds like a safe place to go to me if my insurance will allow it with a referral.

Bill
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