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SeanMA 08-16-10 10:27 AM

Treatment suggestions for chronic achilles paratenonitis
Not to be confused with achilles tendinosis, or the old general term, achilles tendonitis.

The heal chord is fine, it's the paratenon that's inflamed.

I'm Looking for any suggestions on the treatment of chronic paratenonitis. I've had this injury since February (ruining this years cycling season), and conservative treatment consists of R.I.C.E, but surgery is suggested if the condition lasts longer than 6 months. I'm past month 6 and conservative treatment isn't really working. There's still pain, and visible inflammation.

I don't have any health insurance right now (because it would put me in the poor house) so surgery is out of the picture. I'm wondering if there are any other exercises or treatment options out there that people have had good luck with.

I've seen articles on the use of eccentric loading for achilles tendinosis. Some articles say eccentric loading should not be used in treating CAP, because it could make it worse, and other articles suggest it. I tried it, and it definitely caused further inflammation, so I stopped.

I've also seen it treated with active release techniques, but I probably shouldn't do that while there's still inflammation, correct?

I'm sick of popping NSAIDS, and I'm getting desperate here, so any input would be good. Thanks!

vega2614 09-07-10 08:49 PM

I had what I think was a bursitis where the achilles tendon inserts into the heel bone for about 3 years, so not the same as you but maybe this advice could apply. I was taking NSAIDS pretty much every day. I never had significant bike pain in that area, but running and even walking was painful. I went to a physical therapist and he thought it was a combination of poor biomechanics and lack of strength to support the abnormality. I think I had sprained my ankle a few too many times, which led to my foot/leg adapting in a way that was causing me pain. I also had pain in the large tendon behind and laterally to the knee after my first century. It lasted about 6 months and really hurt to ride. More on this later...

Anyways, the treatment plan for both issues was essentially to strengthen up the muscles involved. In my case, doing calf raises and strengthening the gastrocnemius (calf muscle) helped significantly. With a backpack filled with about 25 pounds of stuff, I stand with more than half of one foot hanging over the edge of a step (other foot is off the ground), and while supporting myself by holding a wall or something, I raise up as high as I can go, then dip my heel below the plane of the step, and repeat. I started with using two legs to rise up, then drop with one leg, but now my calves are strong enough to do it all on one leg. I do this every day, usually while waiting for the train. People sometimes look at me weird, but it's a great time to do it.

At first I thought it was counterintuitive to stress the muscle/tendons where the pain was, because my achilles tendon was what was hurting me, but after a little while, the exercises started to feel good. I also started using Superfeet insoles because the insole helped to immobilize the foot into a better position. These insoles also make riding with my clipless shoes much more comfortable than the stock insoles. The calf raises not only lessened the bursitis pain during running and walking, but also ended the tendon pain behind my knee. My point (and the therapist) is that biomechanically, pain in one area could be entirely due to a weakness somewhere else. Unfortunately, the other idea the therapist often stressed was that the human body is ridiculously complicated and it's very difficult to determine why the problem you're having arises.

The very best option is to see a physical therapist if you can. You might need a referral from a physician, but in my experience, their advice is usually useless; "You should rest it, do some stretching, and take NSAIDS" (no ****). It sounds like you spoke to someone in the know about active release techniques, but consider seeing someone else that can address the inflammation and give you exercises that would be safe for your condition.

If seeing a trainer is not an option, I would consider doing some leg strengthening exercises if you can somehow bring down the inflammation. I didn't have significant inflammation, which I think is more common for chronic injuries. It just hurt. How do you know your paratenon is actually full-on inflamed? Consider squats, lunges, stair climbing (with or without weights), calf raises, standing hamstring curls (stand on one leg, bring heel to butt), etc.. But I'm not a trained professional so don't go crazy with it. If the pain feels wrong, then please stop. I had pain when I started with the calf raises, but it felt like a good pain as in I was working the muscles and tendons, if that makes any sense. It also served the function of stretching the tendon. A doctor also said to consider supplements like fish oil and multivitamins. Maybe even glucosamine and chondroitin. Worst case scenario, they don't work at all, but I don't think these would hurt anything.

Hope you get better soon. I know how much it sucks not being able to ride due to pain (stupid behind the knee tendon).

kevthered 10-29-11 01:17 PM


I've been suffering from Achilles pain for the last couple of years, then in June this year, I suffered a complete tear of my calf muscle (warming up for a game of volleyball on holiday !!)

My calf is now well on the way to being fully recovered, but a recent MRI scan has confirmed I have Achilles Paratenonitis.

What I'd like to know is, how have you managed yours (best treatment etc), and are you now pain free ?

Any help / advice / info you give me would be greatly appreciated.
Thanks very much

Campag4life 10-29-11 03:48 PM

My comment is...if you want to keep cycling then you need to examine your pedal stroke, arch support and cleat location.
Torque by definition is force X distance. The foot is a lever. The longer the foot, the more torque is placed on the achilles. To shorten the foot and reduce torque on the achilles, move your cleats rearward. I ride with my cleats back about 13mm from under the ball of foot with Speedplay pedals. I wear an 11 shoe so this reduces the pressure on my achilles. You also need to immobilize the foot in the shoe. This is done with a proper orthotic. Also, a good idea to evaluation your cycling....maybe cut down on the miles and perhaps most importantly, increase your cadence and don't push as big a gear. That would be my suggestion short of what you already know. Rest is the bane of all of us who want to ride thru our injuries but that can be difficult. If you want to keep riding, consider what I wrote. Ankling during the pedal stroke is also an issue if you are prone to pedal that way.

jdon 10-29-11 04:44 PM

Medically, I have been in the same boat for about the same amount of time. Before surgery, I opted for ART, Acupuncture and Laser treatment. NSAIDs and Ice packs after treatment. 6 weeks in and it is feeling really good. Surgery no longer required. Good luck.

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