Achilles pain (stairs are painful, running painful, small tear?)

Hi everyone,

Thank you in advance for your help and for reading! I have a question regarding pain in the achilles tendon.

I will give you some background that may help. I am 23, and I have been an active runner since I was about 16. At my university, I ran track and field and cross country. This year, after graduating, I have continued to run daily (between 4 and 7 miles daily usually with one day of rest) and to do mild speed training workouts. I have never had a major injury, only a few very minor aches and pains now and again like shin splints. For the most part, however, I have been very lucky. I consider myself to be in good health, and remain athletic.

However, about 20 days ago I twisted my left ankle. It hurt very bad in the first moments, but then it felt ok to keep running. By the afternoon, it was swollen near the top part of my ankle and painful to walk. I took some ibuprofen, iced it, and wrapped it. Within about two days, it was feeling fine and no pain at all. I went for a short run, and had no trouble. Even so, at this time I was traveling around a lot so I figured I would lay off of running during that week just in case. I did a lot of walking, but there was no trouble, and no pain.

After returning home at the end of the trip, I went for an easy run, about 50 minutes at a very easy pace. Again with no trouble, no pain, and everything seemed fine. The next day, however, at the start of the run I began to feel a slight pinching/stinging feeling in my achilles tendon on my left foot. I thought it was just my sock or running tights pinching me, but even after readjusting these, the "sting" was still there. It was nothing very painful initially--just a slight stinging and it did not interfere with my running at first. However, throughout the run (about a 50 minute run again), it grew gradually worse. By the end, I could still walk but running was quite painful and I can still best describe the feeling as a "stinging" in the achilles tendon. When I stopped and walked, it still hurt though not as bad as while running. I noticed it was a little inflamed, so I put some ice on it thinking it was something that would go away or soreness from taking a short break from running while on my trip.

The next day, however, I had a lot of trouble going down or up stairs. I had to hobble along by holding the handrail. While walking, my achilles still "stung" and I could not walk smoothly or without pain all day. When I took a look at my achilles, it was definitely swollen compared to my right foot. Furthermore, there was a slight "bump" in the swollen area about 1.5 inches up from the bottom of my foot. Just at the area of the achilles that is usually smooth. The bump was not hard or a knot or anything, but more of inflammation as far as I could tell. I could feel it and see it. I put ice on it again, and took a day off from running because I was nervous, and also because I could no longer bend my foot upwards or downwards without pain. I could also not go up on my toes without the pain intensifying. When I needed to walk places, there would still be twinges of pain and I became very scared that it felt like threads slowly tearing. Not aching pain, but always more of a "sting."

As a runner, my biggest fear is to tear or damage my achilles tendon. I am certain it is not a complete tear or anything like that. I would have felt far more intense pain. It is clearly still connected, and doing a 'Thompson Test' by squeezing the calf muscle, my foot still moves. Furthermore, I went in to see a doctor and he said that it is not torn but only examined it by touch, not with an MRI. I am currently living in Japan, and often in Japan sports related injuries are not taken quite as seriously as they are in the United States. Although I speak decent Japanese, I also cannot be sure if I was able to explain the situation as clearly as I could in English. The doctor was apparently a foot and ankle specialist, but not a specialist in sports injuries or athletes, and not accustomed to running injuries either (mostly just sprains and twisted ankle, etc.) I wanted to try to get an MRI, but in Japan (at least where I am now) because these injuries are not taken as seriously, it will be difficult for me to convince a doctor to okay it, and take at least another week. The doctor was also convinced that my achilles pain was due to twisting my ankle, despite the fact that I had no pain even near my achilles at that time or in the week after. I am sure it is possible that the events are connected to each other, but I cannot be sure. (He also said it may be an achilles "strain" or "sprain." I am not certain, but is this not the same as a small tear?) His only recommendation was rest, ice, and painkillers when necessary.

My worry is that it is a small tear. Based on all the symptoms I've experienced, they match perfectly with many of the descriptions I have read about small or very small tears to the achilles tendon. I participate in a track and field running club here in Japan, and I have taken another full week off from running already because it hurts to go on my toes or to run. And I am still scared to cause more damage or potentially worsen a tear if there is one. During this past week of rest, I have tried to keep off my feet, to do some mild stretching, and to ice as much as possible. This has helped some. The inflammation has gone down some, but tends to increase with activity such as walking or stairs. It still feels different from my right achilles tendon, and not as "smooth" as it should be. The pain is not so bad anymore while walking, but I do have trouble going up on my toes, and this brings the pain back fairly quickly.

This is by far the longest amount of time I have been forced to take a break from running (in total, about 18 days at least if I count all the rest when I twisted my ankle up until now). I take achilles injuries and pain very seriously because of my nervousness about a full tear, and how debilitating achilles problems can become. At the same time, running is a huge part of my life. I am accustomed to running every day, and I feel unhappy and am loosing hard-earned running fitness during this time. If there is a possibility that it is a small tear, than I will remain patient and do my best not to run until it is safe. I do not want to risk a full tear. At the same time, I want to get back to running and have no way of knowing when might be safe to do so.

But I would like to know if anyone thinks it is possibly a small tear, or if anyone has any other opinions? Prior to the onset of this pain, I have never had achilles pain or issues before. It all seemed to start "stinging" over the gradual course of one 50 minute run and now has stuck with me. Furthermore, does anyone have suggestions for how long I should rest and not run? Things I can do? Should I insist on an MRI? I'd like to get back to training, even if it is cautious and light training.

Sorry for the long question, but I wanted to be as specific as I could. I'd greatly appreciated advice or answers.

Thank you so much!

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