Peroneal tendinopathy

[goddardsharon482]

I'm not a very hardcore cyclist, I just cycle to work each day (about 3 miles each way). I ride a hybrid and don't go particularly fast. I hope no one minds me posting on here, but the cycling is a cause of my injury, and I haven't found a general health forum where many people respond to Achilles tendon posts.

I've been struggling with Achilles tendinitis in my left ankle since I damaged it dancing in 2012. In August 2017 it got very bad and I was off work for 3 weeks, and have not really been normal since. In around October 2017 I damaged my right Achilles when I was cycling to work. Because the left was still not good, I had overworked the right one trying to compensate.

Now both have flared up at once, and I am at a loss for what to try. Last year I tried physiotherapy, but this didn't work out well. The repetitive nature of physio exercises I think really irritates my tendons, and they just kept failing. There is certainly no way I can do the number of reps the physio wants me to be able to do!

The other major problem I keep coming up against, in terms of getting taken seriously - I am not in much pain. When my tendons are starting to fail I feel a sensation of numbness and weakness, usually in one side of the ankle to start with. This gets stronger and stronger until I start limping and ultimately can't walk. If I force myself to walk then I start getting some pain, so obviously I stop forcing myself to do what is hurting me. Maybe I am just stopping activity before most patients would? Anyway, when I went to physios they were confused, because I didn't really feel any pain when they were manipulating and palpating my tendons to diagnose me. They went with a diagnosis of Achilles tendinitis because of the location of the symptoms I do have.

I tried 2 different private physios and an NHS physio. Both private physios thought I should be able to do more than I could (believe me I tried!) - they were pretty keen on loads of heel raises, but I could never get above 10 double raises (both feet). I am sure I re-tore my tendons trying to do all these heel raises, it set me back massively. The NHS physio suggested I start with a Theraband to build up strength. I didn't get to see her again as it was an emergency one-off appointment, but I got the impression she would have gone down the heel raises route as well after a few weeks with the Theraband. None of them thought I had a major problem, as I wasn't in much pain.

I have also tried heel drops in the past, this was a massive mistake and even the physios told me to avoid them.

Currently I am on crutches to try and offload. Over the last 6 months my ankles have fluctuated quite a bit. I had periods when they improved and I started cycling to work again, then something that seems really minor happens, like I wore a smart pair of shoes for a day, or I had to push a bit on my bike to be safe in traffic, and they flare up again. I can't do any exercise or physio at the moment.

I am a 38 year old woman. I am 164 cm tall and about 55 kg. When I'm well my main exercise is cycling to work. I also do ballroom dancing (1 - 2 hours per week, but just as a hobby, not competitively or anything), gardening and walking at the weekends. My doctor says to rest, but I am worried that from how this is dragging on it is more serious. But don't know what chance I have of further investigation on the NHS

Sorry for the long post, I am desperate for help and tried to include lots of detail. I am worried I will never be able to go back to cycling again, as it was the cause of the injury to my right ankle. Any thoughts greatly appreciated!

[Fraz101]

So I snapped my Achilles' tendon around 10-12 years ago playing football.

Complete 100% rupture and was re joined with surgery.

Sounds painful but there was zero pain whatsoever just couldn't feel my foot

I was in cast for 12weeks and 12 weeks of physio there after.

Stretching,stretching and more stretching then muscle build up, thankfully I made a complete recovery and have managed to regain complete range of motion in my ankle, the only thing I'm left with is a 6" scar and a very thick tendon.

I've got to say that the physio I had was extremely good and I also put real hard work and pain into doing the exercises I was given to do each week.

Probably not much help to you but thought I'd share.

[NATURAL ANKLING]

Hi,
I am suffering at the moment so I can sympathise, but I do have and have had pain.

NHS physio's I rate highly and have seen many all good.

Dancing its a bit like climbing a ladder, will get harder in old age and certainly harder on those tendons, I have found.

Did you get a clear diagnosis from NHS physio?
I would of thought that dancing is off the cards for what you are struggling with.
You are not that old, but what other continuous exercise have you done in your life?
I get the impression that modern living is no good for those tendons, that is that without a regular exercise to keep them good or just plain daily hard work, they are too soft to cope with anything that tests them like walking up hills running for a bus and leaving the ground becoming air born as take off and landing is on the ball of foot.

Are you good at disciplined exercises, or are you impulsive....I got to ask?
Can you straighten your leg with foot mid planted on the pedal?

Running and sprained ankle injuries along with ruptured tendon...........recovery from are mostly all pretty much the same, stretching, and isometric heel drops / raises, the one I do every day for several years is to lower on one foot and raise on the other in a circle, ball of foot on a step, 15 reps, then rest or go a make a cup of tea and repeat for other side, as far up and down as you can go, hold onto a banister etc with one hand.
Obviously you need stretching first with your problem, before you could do the heel drops etc.
There will be pain doing a new exercise for rehabilitation and the physio should of said that, normally it fades after 10 days or so.
When I fell of my bike a while back I could not get on / off floor or walk with out crutches without experiencing chronic pain which made me wince, but I was given exercise and had to stick with them.

Diagnosis by qualified physiotherapist (you should not be paying so NHS via your GP.)
Exercises / what they recommend!
Keep it up.
Grow some £@%%$

[Cyril Haearn]

Try rest and different sorts of exercise, get other opinions. Is you bike set up right?
Google these fora, might be something here already
You could try riding an ElliptiGo

[foxyrider]

IME of tendonitis (several times in different joint areas back in my 20's/30's) the key to recovery was to maintain mobility without over stressing the tendons. It was often a drawn out affair and the flare up was generally caused by over enthusiasm after relative inactivity.

For me, a few days rest to allow the inflammation to subside followed by gentle exercise without stressing the affected area and building slowly from that.

You mention ballroom dancing and I guess you wear heels for that - continual wearing of heels can result in contraction of the Achilles which may be a contributory factor here. Do you get pain in heels or only when you wear flat footwear? Do you pedal toes down? Practising the art of 'ankling' (several fora here on that) will give a gentle stretching and strengthen the ankles whilst also improving your power transfer.

I'm not sure that the cycling has caused the second ankle to flare up, from my experience compensatory injury in the legs is pretty much always muscular and affects the knee specifically. (a succession of left leg injuries have always resulted in right knee soreness regardless of where the left leg is damaged)

Good luck and be patient

[NATURAL ANKLING]

Hi,
What does your GP say?
What does your Physio suggest?
What other exercise have you done like hill walking jogging etc?
Your problem could be complex.

I have in the past done everything, long distance walking with camping gear, marathons including forest training with rugby boots for grip, much cycling 250 mile days,....................but my Achilles tendons have gone softer with age, maybe less flexible, so its easy for me to stress them with things like crouching / squatting on toes to get low to ground! Ladders etc.
Don't Squat on your toes, it even gave me knee problems, tough as I am.

I do daily exercises for them and my unstable ankles.

You need correct diagnosis if you are constantly on crutches!
Be honest with us on your ability to follow schedule of exercises.

Good luck.

There is no quick fix for tendon injurie / weakness.

[crazydave789]

just a thought - have you been fitted to your bike?

saddle heights can make a big difference to some people. as can the gears you use to ride and set off in. trying to churn a big gear from traffic lights can put stress on tendons muscles and ligaments. ride a bit slower and allow more time to get where you want to be.

buying a spin cycle for home might be an idea to raise your cadence in a lower gear and a stepper. a bit of tai chi might help alter your stretching routine.

[xjs]

What shoes do you wear for the dancing? Could they be damaging your ankles?

And what others have said - maybe you've been pushing too big a gear on the bike...

[steve browne]

PM sent.

[david7591]

Loads and loads of heel dips and calf stretches morning and evening repeated for many weeks worked for me, but perhaps my tendon was not as badly damaged as the Original Poster’s

[goddardsharon482]

Wow thanks for so many responses. A few questions were raised by multiple posts, so I'll respond to those first.

In terms of can I follow a disciplined physio programme: I have had physio for various previous injuries, inc. Sprained ankle, frozen shoulder, tight ITB and a neck injury. For those my therapists were always impressed with my dedication and I recovered well. I am familiar with the concept of sometimes it gets worse before it gets better. But with these achilles problems I have lost a lot of confidence, these feelings of numbness keep coming back when I do physio exercises - I actually had my worst set back when I was following a supervised physio regime of heel raises last year.

The dancing is another thing that has perplexed my physios because they expect that to be something I really can't do. I avoid it when I can't walk without a limp, but otherwise I seem to improve when I dance. I do wear 3 inch heels, and the tendons do prefer being shorter. I also think the tendons like the variety of different movements when dancing, but one physio said that is exactly what should aggravate my tendons. My impression after all this time is they dislike repetative actions as required by physio exercises!

[goddardsharon482]

Fraz101, thanks for your response. I am glad you have recovered now! I find your response really interesting, that you had pretty much the worst Achilles injury but no pain. Pain seems to be fundamental to a clear diagnosis. Can I ask, what did you feel during your recovery?

[goddardsharon482]

Regarding bike set up, I was 'fitted' at the bike shop (Evans) when I bought my bike. Basically, saddle high enough that I nearly straighten my leg at the bottom of a stroke, low enough to still put the ball of my foot on the floor when I stop.

I cycle with the peddle in my arch/slightly to the front of the arch. I try to avoid standing up on the peddles these days, but sometimes it's hard because you need a burst of speed!

Gears: I use the middle large gear, and 3rd - 6th small gear (it's a hybrid 21 gear bike).

[crossfire]

Have you tried a sports physio? my daughter injured her back/neck falling off a stool and has had good results from a specialist in sports injuries which I suppose this would come under
john

[Fraz101]

Fraz101, thanks for your response. I am glad you have recovered now! I find your response really interesting, that you had pretty much the worst Achilles injury but no pain. Pain seems to be fundamental to a clear diagnosis. Can I ask, what did you feel during your recovery?

During recovery it was pretty painful to stretch but nothing really bad.

Some people report that the sound of an Achilles' tendon snap is very loud and audible, however I wasn't aware at all of the seriousness of it, it,just felt numb, I even played the remainder of the 5 aside football match standing in goals, then drove home 15miles,didn't in fact go to a and e until the next day,as I still couldn't feel my foot properly.