Achilles pain and shoe adjustment

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rodneycc
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Achilles pain and shoe adjustment

Postby rodneycc » Sun Feb 12, 2017 12:49 pm

My achillies is driving me nuts at the moment.

I hurt it a week or two before Christmas (I suspect playing golf) and its real painful when its not warmed up. I suspect bike riding is delaying recovery. I spent a week and a half off the bike and thought it was coming good but after the last two rides I seem to be back to square one hobbling around when idle.

My Sidi shoes have a back/heel adjustment which I think I might have a go changing but not sure if I should go in tighter or out looser. I am leaning towards looser as the back of the tendon is a little sore to touch.

Anyway, anyone got any advice in recovery from this. My ankles in general are pretty average.
Cheers.
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ValleyForge
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Re: Achilles pain and shoe adjustment

Postby ValleyForge » Sun Feb 12, 2017 4:09 pm

If the area is red after a ride, well, yes loosen off. But if there is no local redness due to pressure, I'd think it's not going to help.

Rest will. Anti-inflammatories probably. And you don't want an Achilles rupture.
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Re: Achilles pain and shoe adjustment

Postby Dodgy-Knee » Sun Feb 12, 2017 6:44 pm

Cycling will place a fair amount of stress over the Achilles/heel region ... remember the basics first: RICE - rest, ice, compression and elevation ... allow the injury to heal and the inflammation to go down even if it means no cycling for 1 or 2 weeks (and no golf either...)

Taping the heel region may help... the injury could be just in the tendon or where the tendon inserts into the heel bone so extra support never goes astray.

Have a look at these to give you an idea of what you can do:
https://www.youtube.com/watch?v=JYq0fPSrqQ0
https://www.youtube.com/watch?v=jzh_cYmZX_4
https://www.youtube.com/watch?v=5tUnZX358dk
https://heelthatpain.com/home-remedies/

I have Sever's in my left heel and it's a pain in every sense... I tape it up with the Elastoplast version of KT tape ($10 from Chemist Warehouse) and it helps a lot ... your injury might be different and might require different taping but as I said at thew start, the initial treatment will be the same ie. RICE. Also, remember very gentle stretches of the calf and Achilles once you start riding again.

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Re: Achilles pain and shoe adjustment

Postby rodneycc » Sun Feb 12, 2017 7:13 pm

Thanks guys might take some more time off the bike and then try the taping when I return to it.

I'm going to a vascular surgeon on Wed for my other foot and ankle where I have a few puffy achey veins (which isn't really
as sore as the achillies to be honest but my GP sent me off there). So I might ask her if she can do anything as well. Prob just needs more time (nearly 2 months and counting!).

Edit: oh Severs... I have a nasty feeling this might in fact be it as the pain/soreness is really low down on the achillies like this. How long until that goes away if treated right? Is severs constant pain? As mine seems to go away when warm.
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ValleyForge
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Re: Achilles pain and shoe adjustment

Postby ValleyForge » Sun Feb 12, 2017 8:20 pm

Dodgy-Knee wrote:I have Sever's in my left heel and it's a pain in every sense... .

Ahh, Sever's is a paediatric disease. It is peculiar to the calcaneal (heel) growth plate in children.

How old are your heels?
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martin_12
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Re: Achilles pain and shoe adjustment

Postby martin_12 » Sun Feb 12, 2017 9:11 pm

Stretching and eccentric exercise fixed my achilles problems.

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CKinnard
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Re: Achilles pain and shoe adjustment

Postby CKinnard » Sun Feb 12, 2017 9:53 pm

You'd benefit from a comprehensive assessment, which you might have to hunt around for as it is time consuming.

Factors to be clarified:
- age, general health, gender (well, in this day and age of gender fluidity and preferred pronouns!)
- previous injuries to tendon, calf, foot (if the tendon or insertion has been damaged previously it will be more prone to recurrent damage.
- current history. you say you did it at golf. that's unusual and needs elaboration.
- asymmetries in lower limb lengths or heel shape or tendon thickness.
- medical history
- demands on feet and ankle from occupation and other sports
- shift worker, standing job
- diet, nutrition, hydration habits
- sleep quality
- overweight/obese = higher load through tendon
- shoes worn most of the time

Achilles issues are more common in people with larger calf muscles who usually have higher % of fast twitch fibers (mesomorphs). These types tend to be bull at the gate types who walk more on the forefoot and push their toes into the ground firmer, which loads the achilles tendon more than someone with gentler toe off.

Therapy wise,
- healthy diet, hydration, and sleep makes all the diff.
- get your calfs massaged heavily. old scars can shorten/tighten the calf and load the tendon excessively. get your hams done at the same time. achilles issues are highly correlated with tight hams.
- have your lower back checked. sciatic nerve irritation can compromise healing rate via vasculature and neuro/immune interactions.
- contrast ice/heat is used broadly in professional sports for recalcitrant conditions such as this.
- if an office worker, keeping your leg up on a coffee table or similar will enhance circulation. (it's all abut the circulation and what is being circulated.)

There's lots of dodgy taping technique being peddled these days. At an elite level, if it isn't mechanically unloading the tendon, then forget it.

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Re: Achilles pain and shoe adjustment

Postby baabaa » Sun Feb 12, 2017 10:18 pm

Hmm, nasty, frustrating and overall a real pest. I found that taping at all times and a deep self massage every night helped my achilles tendonitis which came more from running than biking. Taking it very, very slowly in recovery and a change of the brand of running shoe was the long term key to prevention. Oh, and if you are into triathlon I suggest you try not to combine straight off running then onto biking or visa versa training for a while, cool down slowly then after a few hours do the next type of training. Also, try not to bounce out of bed in the morning!

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Re: Achilles pain and shoe adjustment

Postby Dodgy-Knee » Mon Feb 13, 2017 12:55 am

ValleyForge wrote:
Dodgy-Knee wrote:I have Sever's in my left heel and it's a pain in every sense... .

Ahh, Sever's is a paediatric disease. It is peculiar to the calcaneal (heel) growth plate in children.

How old are your heels?


My body is OLD but my feet are young and sprightly!!!

Yes, I know Sever's is a paediatric syndrome... the guts of it is an inflammation of the achilles at the point of insertion into the heel bone due to overuse

Technically, it may not strictly be called Severs ... on a practical basis though, it hurts enough to call it whatever you want... taping it up as per Severs fixes the problem so who wants to pick nits?

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Re: Achilles pain and shoe adjustment

Postby g-boaf » Mon Feb 13, 2017 11:24 am

rodneycc wrote:My achillies is driving me nuts at the moment.

I hurt it a week or two before Christmas (I suspect playing golf) and its real painful when its not warmed up. I suspect bike riding is delaying recovery. I spent a week and a half off the bike and thought it was coming good but after the last two rides I seem to be back to square one hobbling around when idle.

My Sidi shoes have a back/heel adjustment which I think I might have a go changing but not sure if I should go in tighter or out looser. I am leaning towards looser as the back of the tendon is a little sore to touch.

Anyway, anyone got any advice in recovery from this. My ankles in general are pretty average.
Cheers.


Listen to Ckinnard - and make sure you take it VERY easy until you get the issue sorted out or you'll be off the bike for a long time as I was last year. My injury wasn't just a not able to ride severity, mine was so bad that I couldn't walk even without pain, so that was forbidden too. If you don't get this sorted out properly, it may be something that will permanently affect you, that was the warning I was given.

I wished Ckinnard had written what he did above earlier, because it sort of made sense how my injury occurred.

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Re: Achilles pain and shoe adjustment

Postby rodneycc » Mon Feb 13, 2017 11:53 am

CKinnard wrote:You'd benefit from a comprehensive assessment, which you might have to hunt around for as it is time consuming.

Factors to be clarified:
- age, general health, gender (well, in this day and age of gender fluidity and preferred pronouns!)
- previous injuries to tendon, calf, foot (if the tendon or insertion has been damaged previously it will be more prone to recurrent damage.
- current history. you say you did it at golf. that's unusual and needs elaboration.
- asymmetries in lower limb lengths or heel shape or tendon thickness.
- medical history
- demands on feet and ankle from occupation and other sports
- shift worker, standing job
- diet, nutrition, hydration habits
- sleep quality
- overweight/obese = higher load through tendon
- shoes worn most of the time

Achilles issues are more common in people with larger calf muscles who usually have higher % of fast twitch fibers (mesomorphs). These types tend to be bull at the gate types who walk more on the forefoot and push their toes into the ground firmer, which loads the achilles tendon more than someone with gentler toe off.

Therapy wise,
- healthy diet, hydration, and sleep makes all the diff.
- get your calfs massaged heavily. old scars can shorten/tighten the calf and load the tendon excessively. get your hams done at the same time. achilles issues are highly correlated with tight hams.
- have your lower back checked. sciatic nerve irritation can compromise healing rate via vasculature and neuro/immune interactions.
- contrast ice/heat is used broadly in professional sports for recalcitrant conditions such as this.
- if an office worker, keeping your leg up on a coffee table or similar will enhance circulation. (it's all abut the circulation and what is being circulated.)

There's lots of dodgy taping technique being peddled these days. At an elite level, if it isn't mechanically unloading the tendon, then forget it.


So 46yo Male, 178cm, Med/Large build of 100kg so yes overweight mainly in the stomach area, everywhere else is pretty good. Good development of the legs/hams/calfs. No real history of hamstring, calf or Achilles problems before. General Health good (had a 45year old blood test with my GP and came back all good) I have had a few ankle issues which I gave up cricket about 10 years ago - I can't squat without feeling stiffness in the ankle region the next day). Cycling recreationally for 4 and a bit years now about 3500-4000kms a year commuting and weekend rides. Diet not great and Sleep pretty terrible with an intellectually disabled child waking 2-3 times a night (I'm in bed for 8 hours a night but my fitbit tells me I'm only averaging about 6 hours of real sleep with being up a couple of times a night).

Office worker with sit down job, recently moved offices/desks/chairs. Mainly wear sneakers all year round to work (New balance with good support). Hard Tiled floors at home which I do have trouble with when have no footwear on so try and wear padded slippers or scuffs most times. I don't get to sit much at home so I would be on my feet for 5-6 hours a day there.

I'm not sure 100% how I did the injury. I suspect it was the golf but not certain. I wouldn't be surprised if it was a few things in that week that has triggered it. I did a long (for me) 85km ride earlier in the week before the golf. Felt ok after it. A few days before that I changed offices/chairs (may also contributed). Played golf which I hadn't done for about a year - felt good - nothing obvious that afternoon or night but woke up with a sore Achilles in the morning and pretty much struggling ever since when idle or cold. When its warm its fine so when riding for example it feels fine. It also gets a little sore to touch down the base of the Achilles where it meets the heel (like at the insertion between the two like at the place of the severs disease). Tiny little bump hardly anything really like you see in other tendonitis cases.

Anyway thanks for your comment. I'm not a real massage fan but I'll take note of the therapy points and try a few things and talk to the Doc on Wed about any other circulation things that can help (the varicose vein under my other foot is unrelated but while I'm there I probably should talk about the thing that is causing me more problems at the moment!).
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Re: Achilles pain and shoe adjustment

Postby CKinnard » Thu Feb 16, 2017 11:23 am

a couple of red flags there:
- diet and sleep are compromised.
- you are clinically obese.
- your feet cannot tolerate walking barefoot on tiles.
- you have arthritic like symptoms in the feet (cannot squat, etc).

all this points to poor circulation in lower limbs, poor nutrition, increased mechanical loading of the achilles due to stiff ankle and foot joints, poor recovery capacity due to sleep and nutrition compromise.

By all means bring it up with your GP, but few are knowledgeable in the importance of lifestyle factors in helping degenerative conditions such as yours.

Even if you did everything optimally, you will not get a quick fix to this problem, and the achilles will be prone to recurrent injury for a year or more.

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Re: Achilles pain and shoe adjustment

Postby rodneycc » Thu Feb 16, 2017 1:14 pm

CKinnard wrote:a couple of red flags there:
- diet and sleep are compromised.
- you are clinically obese.
- your feet cannot tolerate walking barefoot on tiles.
- you have arthritic like symptoms in the feet (cannot squat, etc).

all this points to poor circulation in lower limbs, poor nutrition, increased mechanical loading of the achilles due to stiff ankle and foot joints, poor recovery capacity due to sleep and nutrition compromise.

By all means bring it up with your GP, but few are knowledgeable in the importance of lifestyle factors in helping degenerative conditions such as yours.

Even if you did everything optimally, you will not get a quick fix to this problem, and the achilles will be prone to recurrent injury for a year or more.


Thanks CK will keep an eye on a few of those things. The vascular surgeon picked up a few probs with my right foot yesterday and back for a few scans and another appointment this afternoon which looks like I will get some treatment to improve circulation for that. But No such luck on the left where the Achilles problem is so going to have to just manage that by the looks.
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Re: Achilles pain and shoe adjustment

Postby Calvin27 » Thu Feb 16, 2017 1:37 pm

rodneycc wrote:But No such luck on the left where the Achilles problem is so going to have to just manage that by the looks.


Hate to say it but mine never really went away, just I got really good at managing it.
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Re: Achilles pain and shoe adjustment

Postby rodneycc » Thu Feb 16, 2017 3:01 pm

Calvin27 wrote:
rodneycc wrote:But No such luck on the left where the Achilles problem is so going to have to just manage that by the looks.


Hate to say it but mine never really went away, just I got really good at managing it.


Any tips Calvin? Do you use tape? I'm thinking about taping it for a little while (even on commutes) and see how it goes. That and my friend Voltaren EmulGel. Going to be time consuming with the tape which I was hoping to avoid.
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Re: Achilles pain and shoe adjustment

Postby Calvin27 » Thu Feb 16, 2017 3:23 pm

rodneycc wrote:Any tips Calvin? Do you use tape? I'm thinking about taping it for a little while (even on commutes) and see how it goes. That and my friend Voltaren EmulGel. Going to be time consuming with the tape which I was hoping to avoid.


I've been on this journey for about 2 years now. A few pointers:

- You do have to let it settle before you start doing anything.
- Lots of painful massages from the physio.
- Get the MRI done and save the rest of the crap if you haven't already.
- Stretches - this won't go away so keep up with the stretches. When off the bike, do lots of these. Eccentric and concentric trice daily.
- Initially loaded all my shoes with inserts supporting raising the heel and supporting the inner foot. Everyone will tell you to do this and it does fix a lot of things, however in my opinion is' a short to medium term fix. In the long-run this makes it worse as it teaches you to heel strike even more and shorten the Achilles even more. I suspect my problem was from heel striking - which started when i started walking to work in work shoes.
- After that I moved to completely flat foot shoes and now I am switching between supported and flat. The goal is to eventually go completely flat foot to stretch out and promote good form.
- Physio recommended uphill grass sprints. This helped build a lot og calf strength but more importantly build correct running form. Walking form is also important but much harder to master. If you are like me, heel striking is really bad, there is good evidence that this is the root cause of many lower leg and foot problems.

As for cycling, i just try to stretch it as much as I can and until i make a bit more improvement trying to do rides that aren't too long - no more than 4 hrs.

Above all BE PATIENT! Recovery takes time, especially the stubborn Achilles. Good luck!
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Re: Achilles pain and shoe adjustment

Postby rodneycc » Thu Feb 16, 2017 5:14 pm

Thanks Calvin. Much appreciated your honest input.
Cheers.
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Re: Achilles pain and shoe adjustment

Postby g-boaf » Thu Feb 16, 2017 6:08 pm

rodneycc wrote:So 46yo Male, 178cm, Med/Large build of 100kg so yes overweight mainly in the stomach area, everywhere else is pretty good. Good development of the legs/hams/calfs. No real history of hamstring, calf or Achilles problems before. General Health good (had a 45year old blood test with my GP and came back all good) I have had a few ankle issues which I gave up cricket about 10 years ago - I can't squat without feeling stiffness in the ankle region the next day). Cycling recreationally for 4 and a bit years now about 3500-4000kms a year commuting and weekend rides. Diet not great and Sleep pretty terrible with an intellectually disabled child waking 2-3 times a night (I'm in bed for 8 hours a night but my fitbit tells me I'm only averaging about 6 hours of real sleep with being up a couple of times a night).

Office worker with sit down job, recently moved offices/desks/chairs. Mainly wear sneakers all year round to work (New balance with good support). Hard Tiled floors at home which I do have trouble with when have no footwear on so try and wear padded slippers or scuffs most times. I don't get to sit much at home so I would be on my feet for 5-6 hours a day there.

I'm not sure 100% how I did the injury. I suspect it was the golf but not certain. I wouldn't be surprised if it was a few things in that week that has triggered it. I did a long (for me) 85km ride earlier in the week before the golf. Felt ok after it. A few days before that I changed offices/chairs (may also contributed). Played golf which I hadn't done for about a year - felt good - nothing obvious that afternoon or night but woke up with a sore Achilles in the morning and pretty much struggling ever since when idle or cold. When its warm its fine so when riding for example it feels fine. It also gets a little sore to touch down the base of the Achilles where it meets the heel (like at the insertion between the two like at the place of the severs disease). Tiny little bump hardly anything really like you see in other tendonitis cases.

Anyway thanks for your comment. I'm not a real massage fan but I'll take note of the therapy points and try a few things and talk to the Doc on Wed about any other circulation things that can help (the varicose vein under my other foot is unrelated but while I'm there I probably should talk about the thing that is causing me more problems at the moment!).



That weight is a real worry, you are a couple of cms taller than me, and 40kg heavier. That can't help much. When mine went last year, it was absolutely terrible, completely prevented me from walking around properly at all and couldn't ride anywhere. And everything they all say above about taking a long time to recover, it does take a long time.

I was also given the insert to put in my shoe to raise the heel. I didn't like it and tried to persist without it.

rodneycc wrote:Any tips Calvin? Do you use tape? I'm thinking about taping it for a little while (even on commutes) and see how it goes. That and my friend Voltaren EmulGel. Going to be time consuming with the tape which I was hoping to avoid.


No, you shouldn't be doing that either. If you must get exercise, then try using one of those hand-cycling machines. You've got to ease up, rest and let it recover. If you see a physio, follow the advice they give you absolutely to the letter.

I hope I'm not sounding too blunt, but I've been down this injury path before you from a much higher level of fitness than you. It was a long recovery for me, so I'm trying to guide you down the right path so you don't go through what I did. Getting back the range of movement in the ankle and that leg was the hardest thing to do.

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Re: Achilles pain and shoe adjustment

Postby baabaa » Thu Feb 16, 2017 6:48 pm

Could suggest a change of sports shoes may also help.
When achilles talk comes up amongst groups of runners the key word is....
Mizuno.
Almost everyone looks left, right and then just nods knowingly. I just won’t risk it with any other shoe now.
FWIW the rear end of Giros seems to be the goods for my biking shoes.

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Re: Achilles pain and shoe adjustment

Postby rodneycc » Thu Feb 16, 2017 9:21 pm

g-boaf wrote:That weight is a real worry, you are a couple of cms taller than me, and 40kg heavier. That can't help much. When mine went last year, it was absolutely terrible, completely prevented me from walking around properly at all and couldn't ride anywhere. And everything they all say above about taking a long time to recover, it does take a long time.

I was also given the insert to put in my shoe to raise the heel. I didn't like it and tried to persist without it.

No, you shouldn't be doing that either. If you must get exercise, then try using one of those hand-cycling machines. You've got to ease up, rest and let it recover. If you see a physio, follow the advice they give you absolutely to the letter.

I hope I'm not sounding too blunt, but I've been down this injury path before you from a much higher level of fitness than you. It was a long recovery for me, so I'm trying to guide you down the right path so you don't go through what I did. Getting back the range of movement in the ankle and that leg was the hardest thing to do.


Thanks for your concern. Yes the elephant in the room (- is me - boom boom) yes is the weight. Cycling hasn't moved it in 4 years so I know it is what I stick down my throat that is the problem. I'm not a big diet fan and I'm not a leafy greens kind of a guy either so I more have to take a stricter approach on the amounts. I know I can do better there.

I have only ridden once in the last two weeks and this has been going on before Christmas so not sure how long I gotta wait. And its annoying the crap out of me I have got to say. The good thing going for cycling is that it actually doesn't hurt to pedal - if anything it feels better than normal. So its more when I come off the bike and later on when I warm down. So I can't see it popping or anything major like that.

I also think its at a stage today that I could or should test it a little. Its not bad at the moment (my memory of this morning is already gone - I've forgotten already what it was like then). A nice little 15kms up and 15kms back commute should be a nice little test. Nothing major and I promise I'll go real gentle Dad :-)
No seriously thanks g-boaf your cautiousness isn't lost on me.
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Re: Achilles pain and shoe adjustment

Postby rodneycc » Thu Feb 16, 2017 9:32 pm

baabaa wrote:Could suggest a change of sports shoes may also help.
When achilles talk comes up amongst groups of runners the key word is....
Mizuno.
Almost everyone looks left, right and then just nods knowingly. I just won’t risk it with any other shoe now.
FWIW the rear end of Giros seems to be the goods for my biking shoes.


Thanks Baabaa, Do Mizuno's come in full black? I mean not as a fashion statement but I need black shoes for work. I get away with the full black New Balance's at work. I actually don't do much other sports but I live in the New Balance's everywhere.
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Re: Achilles pain and shoe adjustment

Postby g-boaf » Fri Feb 17, 2017 6:47 am

Recovery time for an injury of this type can be 10 weeks.

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Re: Achilles pain and shoe adjustment

Postby rodneycc » Fri Feb 17, 2017 8:15 am

Been about 10 weeks now. I was actually thinking it might of been about 3 months to recover like a few other injuries I have had.

Anyway ride aborted this morning. I forgot I wanted to adjust my shoes (heel adjustment). Also its not feeling great first thing this morning. Maybe a smaller one way ride might be better also I was thinking about 10kms first up also so I can abort if any probs.
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Calvin27
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Re: Achilles pain and shoe adjustment

Postby Calvin27 » Fri Feb 17, 2017 9:08 am

baabaa wrote:Could suggest a change of sports shoes may also help.
When achilles talk comes up amongst groups of runners the key word is....
Mizuno.
Almost everyone looks left, right and then just nods knowingly. I just won’t risk it with any other shoe now.
FWIW the rear end of Giros seems to be the goods for my biking shoes.


That's a pretty broad brush. Mizuno make a lot of different types of running shoes from traditional fat heeled to real minimalist zero drop versions. Actually there are a lot of studies that show no real difference in price and brand. I'm a firm believer my injuries was a result of a sudden shift to walking to work in heavily heeled shoes. Prior to that lots of cheap flat shoes - chucks, thongs and volley (cheap uni student).
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Re: Achilles pain and shoe adjustment

Postby baabaa » Fri Feb 17, 2017 9:32 am

That's a pretty broad brush.

Yes, I agree just what I have found after much pain and angst and felt worth highlighting that I am not the only one to have had a good result from a certain brand. That said I do think going to a proper running shoe shop with people who really run can help sort out the best type of shoe ( like any good bike shop, they know you can buy cheaper online but if they do help they know you will want you to come back). Being very neutral any underpronation or overpronation in a shoe or boot gives me much grief.
I now run at least once a week in barefeet on grass, dirt and even gravel, something I would never thought would happen again.

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