I recently treated a patient I have known for many years for a chronic Achilles injury.  Part of the problem was she does not live in San Diego so she had sought treatment where she does live.  Although I agreed that the treatment she received was reasonable what I did not agree with was how her injury and rehabilitation process was managed.  She suffered unnecessarily for two years but is now getting better and back to running!

Achilles tendons can suffer microtears and become tendonosis and painful

  1. What were your initial signs and symptoms regarding your achilles injury? I had localized pain and tenderness in my achilles that was painful upon touch and initial walking/running.
  2. What did you do or try that either helped or hurt to alleviate your injury? Started with Physical Therapy and RICE
  3. What prompted you to eventually seek medical care and advice? It wasn’t getting better and led me to crying while crossing a finish line because I was in so much pain
  4. What was the initial diagnosis? Achilles tendinosis
  5. What did the doctor tell you to do? I went straight to a podiatrist for PRP after researching it.  I wanted a quick fix (after 6 months of trying to run/bike through it)
  6. What transpired after you followed the doctor’s instructions? It was better initially but then the pain came back after approximately 4-6 months (approximately 2 months after starting to workout again)
  7. At what point did you decide to seek help from SDRI (Dr. Allen)? I have periodically come to you for second opinions for previous injuries (can’t do first opinions because I don’t live there.) I trust your opinion and like the way you approach each injury I have had.  The initial pain started in March 2018, I was able to race through it (half ironman early Sept 2018) but the crying finish line was October 2018.  I got first PRP in Dec. 2018.  First time I came to you for second opinion because I still had pain was April 2019 and got a cortisone shot.  It felt better for about 3 months then started to hurt again and gradually got worse while working out and running through.
  8. After I diagnosed you what was your initial impression? I felt you seem to understand the problem and you were looking for different answers and different reasons why it wasn’t getting better. You also never made me feel stupid for asking so many questions or for doing my own research and comparing notes (not that I would recommend this for everyone).  You also were willing to work with my situation of not living nearby and worked to try and find alternatives for me for the recovery process.
  9. Where is your injury now compared to where it was when you first consulted a doctor? I am pain free when walking.  I have been horseback riding without pain.  I have just started to get back into cycling, so far without pain, and running short distances sporadically without pain.
  • What advice would you give someone if they are reading this?

First find a doctor that understands your sport and your mindset and you trust.  Endurance runners and Triathletes are a different breed.  You need someone that will help you get back to doing what you love and is willing to try alternative methods and theories to get you there.   My first doctor understood my mind set and did what I felt was appropriate but it just didn’t work for me, at that point he ran out of options.  Something I appreciate about you is that you were willing to try different things not the standard protocol.

I would suggest getting second (and third and fourth) opinions.  This is super tricky because you need to do some thinking for yourself.  I asked 4 physical therapists and physicians and a surgeon to make sure I had all the questions so I was comfortable with moving forward with any recommended treatment.  I would also never recommend this for everyone but in this case I also consulted Dr. Go