Tag Archives: ultrasound

Achilles Ultrasound – All clear to referee (carefully!)

allclear1 I had the follow-up with my consultant this evening, now that the ultrasound on my achilles had been performed. I had been feeling pretty nervous about this as I’ve been looking forward to getting cracking on with the start of the season, and did not want any upsets!

This was the report:

No plantaris tendon was identified separate to the Achilles tendon. There is unremarkable retro-Achilles bursa measuring maximum 1mm depth. There is a strand of low and less linear reflectivity within the Achilles insertion onto the calcaneum centrally and medially, each measuring approximately 1mm deep and up to 2cm length. No increased perfusion is detected. The mid and proximal Achilles tendon and musculotendinous junction look normal. No retrocalcaneal bursitis is detected. No paratenonitis is detected. No erosion of the calcaneum at the Achilles insertion is detected. No calcification in the Achilles tendon is detected.”

CONCLUSION:

Subtle features suggestive of a couple of fine strands of tendinopathy insertional within the medial and central insertion of Achilles tendon.

Essentially, there is a tiny little tear in there which looks like it has been healing well. ‘Healing well’ is indicated by the fact that no evil calcification or other knock-on effects such as aggravation to the bursa have been happening.

I went through my recent improvements with the consultant (including the new footwear). This included the findings on my severe overpronation and the Superfeet orthotic. The good news is that he approved of all this, and in particular that the orthotic was the appropriate type. In his own words, “You seem to be fixing yourself!”.

He is happy for me to carefully resume refereeing. I have also been referred to a recommended physio (my consultant used them for his ACL tear) to work on continued strength and flexibility training.

Achilles injuries are SLOW to heal (poor blood supply), so I feel there is still a bit of a journey ahead of me with this. It will be good to get back to running and other physical training, as getting the weight down will help with all this too!

Bring it on!

Battling with Insertional Achilles Tendonitis

InsertionalAchilles I’ve been struggling with Insertional Achilles Tendonitis since around February. I really need to get it sorted now, so am going to start blogging about it to maintain some sort of focus.

The history is fairly typical for this sort of injury: Overuse. I’ve been running regularly for years as a football referee. In a typical game, I will travel 10 km in a variety of ways: Walking, jogging, running, sprinting, running backwards, changes of direction… It’s all going on! When fully fit I would also be engaging in training runs of between 5 and 10 km, and last year I did the Great South Run (10 miles) with no problems at all.

I used to be a classic heel-strike runner, but switched to a minimalist style last year. I managed to transition pretty quickly and was using that style for about eight months before the achilles issues struck. Transitioning also solved the knee ligament issues I was suffering from in my left leg! Due to the long time period before the achilles issues came on, I’m not blaming the minimalist style here, but I do accept that it does load the achilles more than heel-striking — That’s how it saves the knee joints from being shot to pieces!

So what happened?

Well, over the last winter we had atrocious weather in the UK. Lots of games were postponed. I was lazy and did not keep up my supplementary training runs. Then it was the Christmas break and I didn’t do anything then either, but did put on a bit of weight! When the season started again the weather continued to be bad, so it wasn’t really until February that I was back to full-intensity games. And that was the problem. I went from a sustained period of doing nothing to resuming my usual refereeing intensity, and at that point the tendonitis started. As is typical, there was no sudden ‘BANG’ moment: it was more of a dull that came on the following morning. It never really went away and has persisted since then.

I would class the pain as annoying. It doesn’t impact my performance per se: I can still run, sprint and so on, but I just end up paying for it afterwards or the next day. Doing two activities in two days is really asking for trouble. Basically, it makes me not want to or enjoy training, and that has gotten worse over time. Not because the soreness has gotten worse, more that I am just getting completely fed up with it.

At the end of last season I took a bit of a break, but short-lived. About three weeks. That isn’t very much for an achilles tendon injury from the reading I have been doing. I then needed to train for my fitness test (Cooper Test and sprints), which I passed with no problem. Then another four weeks of rest before I got a bit over confident and did two 5k runs in two days, and the soreness came right back. Not as bad as it has been though, I will say, but again the fact I am not healed is getting tiresome.

I’ve had some physio during this time but I am left feeling that in my case, it isn’t helpful without giving the tendon time to rest first. Calf stretches cause pain due to the tugging on the tendon. It isn’t the ‘nice’ sort of pain you get when you know a stretch is doing you good. It’s the ‘Please don’t do this!’ sort of pain. There seem to be various references that the best thing to do is ACTUALLY REST IT, and certainly don’t try stretching and strengthening until that painful acute stage is over. Common sense, I guess?

The latest is that I have seen a consultant who has taken X-Rays and an Ultrasound. I’m awaiting my follow-up. The X-Ray has not shown anything out of the ordinary: Perhaps a very slight Haglund’s Deformity but it seemed very, very small compared to some of the example ones on the Internet. Besides, this did come on in an ‘overuse’ scenario. The Ultrasound confirmed a very small (1mm or less) tear. I don’t know exactly where yet until the follow-up. The optimist in me sees this as a good thing in a way: A tear can heal, even if it will take a while, and I’d rather it be that rather than some structural failure.

The immediate plan is more rest until the follow-up in a week or so. I won’t know then whether I should commence refereeing in the new season when August swings around. If I have to declare myself injured for a month or two (maybe more?!) then so be it. The important thing is to beat this. Much as I will be chomping at the bit as a result!

Watch this space…