MRI Results - surgery recommended

I got the detailed MRI results yesterday.  My doc says the broken-off spur in my achilles is irritating and inflaming my achilles tendon and he recommended removal.  he said it’d be two weeks in a splint then six weeks in a boot, then to shoes.  He also wants to chop off my haglund’s deformity and arthroscope the front of my ankle to remove scar tissue which is causing some stiffness.  On top of all this, he noted “chronic lateral ligament tears” - but those will only need PT, not surgery.  No clue why I have those, unless it’s still from a moderate ankle sprain I had in college 20 years ago.

Naturally all this scares me greatly.  Here I was, a lifelong, painfree runner who suddenly has a laundry list of foot problems.  Despite all this, I know my situation isn’t as bad as a full ATR.  The real question for me is:  Do I go through with the surgery?  I’m actually not in a lot of pain walking around right now.  Going down stairs is the worst, but I walked three miles through a local park yesterday with no problems.  My doc says the spur is a “ticking bomb” and getting it out earlier is less trouble than waiting for more damage to occur.

Yay - I have a broken-off Achilles Insertional bone spur

Hello!  First, many thanks to all the others who write blogs here.  I find it very helpful to read about how others deal with their achilles issues.  My case is a bit different than the typical rupture.  After dealing with achilles pains since August 2011, I’ve finally been diagnosed with a long-term insertional achilles heel spur that finally broke off and some point in the recent past.  Surgical removal has been recommended.  First, the back story of my past year dealing with this, for those who are interested.

I was a lifelong runner and never had any problems until March 2011 when I banged my foot at home and broke my right big toe.  Ouch - and not even running or sport related.  My ortho casted my foot for five weeks NWB on crutches, then two more weeks on crutches PWB, and then about two more months of learning to walk again to regain strength and mobility.

I was training for a marathon before I broke my toe, so four months post-broken toe (Aug 2011) I re-started running.  I ran 1 mile, 1 mile, 2 miles, 3, then 4 - over the course of two weeks.  On the 4 mile run I got a sharp achilles pain.  I rested it for a week and then tried another run, only to have to stop after two miles.  I’ve never had any achilles issues before, so I began researching about it.  I figured out I had Insertional Achilles Tendonitis — the pain was right on the back of my heel.  The rest of the tendon was ok and pain-free.  I saw a number of docs and PTs who had widely varying treatments — heel lifts, rest, ice, heat, “go run” –etc.  All over the board.

To summarize Aug 2011 to Jan 2012, all the treatments I tried had little to no effect.  I could walk on flat ground ok, but that was about it.  And not for super-long.  Stairs were painful (especially going downstairs), as was walking more than 30 minutes total per day.  If I walked too much then I’d have much worse pain the following morning.

I finally saw an excellent PT the end of January 2012.  He noted anterior ankle impingement and limited dorsiflexion along with the achilles pains.  The limited dorsiflexion must be an effect of the casting, as I never recalled that being a problem before.  So I was put on a regimen of ankle mobilizations and eccentric heel drops to work both the ankle impingement and the achilles heel pain.  One can affect or cause the other.

These seemed to have some effect and my pain did improve a bit.  This allowed me to walk longer distances, but that was about it.  Still no running for over a year now.  About this time, I requested an x-ray in February 2012 because I had figured out I may have a bone spur at the achilles insertion.  And voila, the x-ray showed I did.  In fact an x-ray from my toe injury in June 2011 showed the spur, so the docs figure it’d been there a long time.

Here’s an x-ray of the spur from Feb 2012:

Fast forward to last week.  I finally had an MRI done by one of the finest foot and ankle surgeons on the east coast.  I just got his diagnosis yesterday.  He said the bone spur had been attached to the heel bone, but has now broken off.  He recommends surgery using a small incision simply to remove the bone spur.  He said “2 weeks in a splint and 4 weeks in a CAM boot” for recovery.

So!  That’s the long background.  One broken toe, then achilles pain, the discovery of limited dorsiflexion, then the heel spur that broke off in my achilles.  Are they all related?  Or is the achilles issue an unfortunate coincidence?  I’ll never know for sure.  Needless to say, having somewhat limited mobility for a year now has been a huge blow.  Though being “smart” and not overusing my aching foot may have minimized the damage.   Again, I’ll never know for sure.

I don’t know whether to have the surgery or not.  I have a friend who’s had THREE spurs removed over the years, all successfully.  He’s a 54 year old multiple Ironman finisher (and fast, too) — though he’s much tougher than I am!

I’m a hardcore researcher and have spent months learning all about achilles injuries.  Yes, I know about ESWT, I tried the ARP Wave device (didn’t like it - and it doesn’t directly address my problem) –

Has anyone else here had a problem similar to mine?  The broken-off achilles spur?  I’d be curious to know how you handled it.  I’m curious if I can manage the pain without surgery or if the spur will simply cause more damage and pain as time progresses.

For now, I’ll keep doing my eccentric heel drops and ankle mobilizations and live with the dull and sometimes sharp pains.