Today was my first appointment with Dr. Chris Fortier, the physician at the Sports Medicine Centre for Excellence in Newmarket. I like him. The X-ray and ultrasound of my right heel were consistent with insertional Achilles tendinopathy. He says the calcification in the tendon is abnormal but doesn't cause any particular problems if the pain can be resolved. He is optimistic that I'll be able to return to running but it will take some patience.
Step 1 is 6 weeks of Alfredson's eccentric heel-drop protocol on a flat surface. The doc thinks that's probably all I will need. I'm skeptical but I've never consistently done 6 weeks of heel drops so who knows? Until now, I've never been certain of my diagnosis so I've never stuck with heel drops longer than a couple of weeks. A lot of my usual activities put my foot into extreme dorsiflexion, which probably hasn't helped.
I should stay active and do things that don't make it worse. That may mean treating exercise like an elimination diet, e.g. try squats on a day when I'm not doing any other workout, and if I'm not sore the next day, try adding lunges the next time. The heel drops may hurt a bit but otherwise, it's best to skip exercise that hurts in any significant way while I'm doing it. Most of my pain comes the next day so these experiments will take a while.
If things haven't improved after 6 weeks, the next step would be 5 shockwave treatments. If there isn't a 50% improvement after 5 treatments, they'll stop. He says shockwave doesn't always work well on insertional Achilles problems because the bursa is so close to the tendon insertion. If I'm still having trouble, the next step would be a PRP injection. Surgery is well down the list of options, and he actively discouraged it. He said feet are more prone to post-surgical infection, and there may be residual pain at the incision site so it may not feel like an improvement. Anyway... we'll start with conservative treatment.
This was a moderately positive appointment so I decided to run some errands in Newmarket on foot so I could celebrate at Kawartha Dairy and claim the Cool Runnings challenge in the Summer Scavenger Hunt (45+ minutes on foot + ice cream). Mmm, Moose Tracks! :)